Multiple economic evaluation of Early Intervention (EI) for young people with first-episode psychosis

Background/Objectives: Participation in employment tends to be low in people with mental disorders. Recent studies show the potential for Early Intervention (EI) in young people aged 15 to 35 with first episode psychosis to help prevent suicide and some of the long term burdens of psychosis to the health care system. Moreover, preventing some of these adverse events may help to facilitate return to workplace and school. However, the cost-effectiveness of EI, including its wider social and economic implications has so far not been explored.

Methods: Three decision analytical models were constructed to compare investment in a community-based multidisciplinary team for EI in first episode psychosis with standard care. Costs and benefits in terms of vocational, educational and criminal justice system related outcomes over a two year period, as well as suicide over a five year period, were modelled. Data on the effectiveness and costs of the intervention were taken from an empirical study in an area of high socio-economic deprivation in South London, as well as from a supplementary review of the literature. Sensitivity analyses were performed to test the robustness of different assumptions in the model, for instance on the cost of interventions including the intangible costs associated with physical and emotional impacts of poor mental health, and the likelihood of return to education or employment.

Results: EI was found to be more cost-effective than standard care as EI was less costly due to significantly reduced costs for employment lost due to early psychosis, given higher rates of employment and returns to education, compared with standard care. Using a minimum wage rate the average savings are £ 2,087 in addition to health care savings. Although the cost of homicide is low for both EI and standard care, the lifetime costs with EI are £ 2,729 lower than for standard care. The annual saving in suicide costs with EI is £ 975 for men and £ 884 for women given a gender difference in suicide rates with lower rates of suicide after EI. The long-term economic impact of EI depends on what happens to readmission rates after a patient is discharged from the EI team. If the readmission rates remain constant, then the expected savings over eight years are £ 36,632. If rates converge immediately after EI team discharge, the figure is £ 17,427. Finally, if the rates converge gradually, the expected savings are £ 27,029.

Discussion/Conclusions: Multidisciplinary team approaches to EI can help prevent some of the long term consequences of mental disorders, including the risk of suicide. This can also have positive economic benefits in terms of decreased homicide. The investment in EI can provide significant benefits of helping young people return to work and education, and actively engage in a normal healthy lifestyle.

Funding: Department of Health in England.

Keywords: Decision support models, early intervention, first-episode psychosis.