Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance

Muralikrishnan Radhakrishnan; Paul McCrone; Louise Lafortune; Linda Everard; David Fowler; Tim Amos; Nick Freemantle; Swaran P. Singh; Max Marshall; Vimal Sharma; Anna Lavis; Peter B. Jones; Max Birchwood

doi:10.1111/eip.12481

Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance

Muralikrishnan Radhakrishnan, Paul McCrone, Louise Lafortune, Linda Everard, David Fowler, Tim Amos, Nick Freemantle, Swaran P. Singh, Max Marshall, Vimal Sharma, Anna Lavis, Peter B. Jones, Max Birchwood

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Abstract

AIM: Early intervention services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost-effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG).

METHODS: EIS from the National Eden Study were assessed using a measure of fidelity to the PIG that rated the presence or absence of 64 recommended items relating to team structure and practice. EIS were then classified into three groups: those with fidelity of 75-80%, 81-90% and 91-95%. Patient-level resource use and outcomes were measured 1 year following inception into the service; costs were calculated and combined with quality-adjusted life years (QALYs) gained.

RESULTS: At a threshold of £20 000 per QALY, the 81-90% fidelity group had a 56.3% likelihood of being the most cost-effective option followed by 75-80% fidelity at 35.8% and 91-95% fidelity group (7.9%).

CONCLUSIONS: The results from England suggest that striving to maximize fidelity may not be warranted, but that dropping below a certain level of fidelity may result in inefficient use of resources.

Original language	English
Pages (from-to)	747-756
Journal	Early Intervention in Psychiatry
Volume	12
Issue number	4
Early online date	31 Aug 2017
DOIs	https://doi.org/10.1111/eip.12481
Publication status	Published - 1 Aug 2018

Keywords

psychotic disorders
early medical intervention
economic evaluation
quality adjusted life years
costs and cost analysis

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10.1111/eip.12481Licence: None: All rights reserved

Radhakrishnan_et_al_Cost-effectiveness_of_early_intervention_Early_Intervention_in_Psychiatry_2017
This is the peer reviewed version of the following article: Radhakrishnan M , McCrone P , Lafortune L , et al. Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance. Early Intervention in Psychiatry. 2017;1–10. https://doi.org/10.1111/eip.12481, which has been published in final form at 10.1111/eip.12481. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Accepted author manuscript, 500 KBLicence: Other (please specify with Rights Statement)

https://onlinelibrary.wiley.com/doi/full/10.1111/eip.12481Licence: None: All rights reserved

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Radhakrishnan, M., McCrone, P., Lafortune, L., Everard, L., Fowler, D., Amos, T., Freemantle, N., Singh, S. P., Marshall, M., Sharma, V., Lavis, A., Jones, P. B., & Birchwood, M. (2018). Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance. Early Intervention in Psychiatry, 12(4), 747-756. https://doi.org/10.1111/eip.12481

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title = "Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance",

abstract = "AIM: Early intervention services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost-effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG).METHODS: EIS from the National Eden Study were assessed using a measure of fidelity to the PIG that rated the presence or absence of 64 recommended items relating to team structure and practice. EIS were then classified into three groups: those with fidelity of 75-80%, 81-90% and 91-95%. Patient-level resource use and outcomes were measured 1 year following inception into the service; costs were calculated and combined with quality-adjusted life years (QALYs) gained.RESULTS: At a threshold of £20 000 per QALY, the 81-90% fidelity group had a 56.3% likelihood of being the most cost-effective option followed by 75-80% fidelity at 35.8% and 91-95% fidelity group (7.9%).CONCLUSIONS: The results from England suggest that striving to maximize fidelity may not be warranted, but that dropping below a certain level of fidelity may result in inefficient use of resources.",

keywords = "psychotic disorders, early medical intervention, economic evaluation, quality adjusted life years, costs and cost analysis",

author = "Muralikrishnan Radhakrishnan and Paul McCrone and Louise Lafortune and Linda Everard and David Fowler and Tim Amos and Nick Freemantle and Singh, {Swaran P.} and Max Marshall and Vimal Sharma and Anna Lavis and Jones, {Peter B.} and Max Birchwood",

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Radhakrishnan, M, McCrone, P, Lafortune, L, Everard, L, Fowler, D, Amos, T, Freemantle, N, Singh, SP, Marshall, M, Sharma, V, Lavis, A, Jones, PB & Birchwood, M 2018, 'Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance', Early Intervention in Psychiatry, vol. 12, no. 4, pp. 747-756. https://doi.org/10.1111/eip.12481

TY - JOUR

T1 - Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance

AU - Radhakrishnan, Muralikrishnan

AU - McCrone, Paul

AU - Lafortune, Louise

AU - Everard, Linda

AU - Fowler, David

AU - Amos, Tim

AU - Freemantle, Nick

AU - Singh, Swaran P.

AU - Marshall, Max

AU - Sharma, Vimal

AU - Lavis, Anna

AU - Jones, Peter B.

AU - Birchwood, Max

PY - 2018/8/1

Y1 - 2018/8/1

N2 - AIM: Early intervention services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost-effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG).METHODS: EIS from the National Eden Study were assessed using a measure of fidelity to the PIG that rated the presence or absence of 64 recommended items relating to team structure and practice. EIS were then classified into three groups: those with fidelity of 75-80%, 81-90% and 91-95%. Patient-level resource use and outcomes were measured 1 year following inception into the service; costs were calculated and combined with quality-adjusted life years (QALYs) gained.RESULTS: At a threshold of £20 000 per QALY, the 81-90% fidelity group had a 56.3% likelihood of being the most cost-effective option followed by 75-80% fidelity at 35.8% and 91-95% fidelity group (7.9%).CONCLUSIONS: The results from England suggest that striving to maximize fidelity may not be warranted, but that dropping below a certain level of fidelity may result in inefficient use of resources.

AB - AIM: Early intervention services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost-effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG).METHODS: EIS from the National Eden Study were assessed using a measure of fidelity to the PIG that rated the presence or absence of 64 recommended items relating to team structure and practice. EIS were then classified into three groups: those with fidelity of 75-80%, 81-90% and 91-95%. Patient-level resource use and outcomes were measured 1 year following inception into the service; costs were calculated and combined with quality-adjusted life years (QALYs) gained.RESULTS: At a threshold of £20 000 per QALY, the 81-90% fidelity group had a 56.3% likelihood of being the most cost-effective option followed by 75-80% fidelity at 35.8% and 91-95% fidelity group (7.9%).CONCLUSIONS: The results from England suggest that striving to maximize fidelity may not be warranted, but that dropping below a certain level of fidelity may result in inefficient use of resources.

KW - psychotic disorders

KW - early medical intervention

KW - economic evaluation

KW - quality adjusted life years

KW - costs and cost analysis

U2 - 10.1111/eip.12481

DO - 10.1111/eip.12481

M3 - Article

C2 - 28857431

SN - 1751-7885

VL - 12

SP - 747

EP - 756

JO - Early Intervention in Psychiatry

JF - Early Intervention in Psychiatry

IS - 4

ER -

Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance

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Keywords

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