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Review
. 2022 Feb 17;22(1):126.
doi: 10.1186/s12888-022-03769-7.

A review of economic evaluations of health care for people at risk of psychosis and for first-episode psychosis

Gemma E Shields  1 , Deborah Buck  2   3 , Filippo Varese  4   5 , Alison R Yung  4   5   6   7 , Andrew Thompson  8   9 , Nusrat Husain  4 , Matthew R Broome  10   11 , Rachel Upthegrove  10   11 , Rory Byrne  5 , Linda M Davies  2
Affiliations
Review

A review of economic evaluations of health care for people at risk of psychosis and for first-episode psychosis

Gemma E Shields et al. BMC Psychiatry. .

Abstract

Background: Preventing psychotic disorders and effective treatment in first-episode psychosis are key priorities for the National Institute for Health and Care Excellence. This review assessed the evidence base for the cost-effectiveness of health and social care interventions for people at risk of psychosis and for first-episode psychosis.

Methods: Electronic searches were conducted using the PsycINFO, MEDLINE and Embase databases to identify relevant published full economic evaluations published before August 2020. Full-text English-language studies reporting a full economic evaluation of a health or social care intervention aiming to reduce or prevent symptoms in people at risk of psychosis or experiencing first-episode psychosis were included. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms based on the NHS Economic Evaluation Database (EED) handbook and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist for economic evaluations. The protocol was registered on the PROSPERO database (CRD42018108226). Results were summarised qualitatively.

Results: Searching identified 1,628 citations (1,326 following the removal of duplications). After two stages of screening 14 studies met the inclusion criteria and were included in the review. Interventions were varied and included multidisciplinary care, antipsychotic medication, psychological therapy, and assertive outreach. Evidence was limited in the at-risk group with only four identified studies, though all interventions were found to be cost-effective with a high probability (> 80%). A more substantial evidence base was identified for first-episode psychosis (11 studies), with a focus on early intervention (7/11 studies) which again had positive conclusions though with greater uncertainty.

Conclusions: Study findings generally concluded interventions were cost-effective. The evidence for the population who are at-risk of psychosis was limited, and though there were more studies for the population with first-episode psychosis, limitations of the evidence base (including generalisability and heterogeneity across the methods used) affect the certainty of conclusions.

Keywords: Cost-effectiveness; Cost-utility; Economic evaluation; Psychosis; Systematic review.

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Conflict of interest statement

Professor Nusrat Husain has been a past Trustee of The Pakistan Institute of Living and Learning (PILL), Abaseen Foundation UK and Lancashire Mind UK. He is the chair of board of trustees of Manchester Global Foundation (MGF) a Charitable Incorporated Organisation (CIO) registered in England and Wales. He is executive member of the Academic Faculty at the Royal College of Psychiatrists, London. He is a NIHR Senior Investigator. He has received honorarium and travel grants from various pharmaceutical industries. Professor Linda Davies reports funding from the NIHR, MRC and UK charities. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
See this image and copyright information in PMC

References

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