TY - JOUR
T1 - Risk stratification for treating people at ultra-high risk for psychosis
T2 - A cost-effectiveness analysis
AU - Ologundudu, Olajumoke M.
AU - Palaniyappan, Lena
AU - Cipriano, Lauren E.
AU - Wijnen, Ben F.M.
AU - Anderson, Kelly K.
AU - Ali, Shehzad
N1 - Funding Information:
O.M.O is supported by a Canadian Institutes of Health Research grant (No: 153022 ) and a Western Graduate Research Scholarship at Western University in London, Ontario. L.P acknowledges the Innovation fund from the Academic Medical Organization of Southwest Ontario and the support from Arcangelo Rea Family Foundation and Children's Hospital Foundation (LHSC) for the UHR clinic at London Ontario (Prodromal Symptoms in Psychosis Early Clinical Treatment: PROSPECT). L.P also acknowledges salary support from the Tanna Schulich Endowed Chair in Neuroscience and Mental Health at the time of this work (2021), and current research support from Monique H. Bourgeois Chair in Developmental Disorders and Graham Boeckh Foundation (Douglas Research Centre, McGill University) and a salary award from the Fonds de recherche du Quebec-Santé (FRQS) . S.A. is supported by a Tier II Canada Research Chair in Public Health Economics , and K.K.A is supported by a Tier II Canada Research Chair in Public Mental Health Research .
Publisher Copyright:
© 2023
PY - 2023/11/1
Y1 - 2023/11/1
N2 - People who are at ultra-high risk (UHR) for psychosis receive clinical care with the aim to prevent first-episode psychosis (FEP), regardless of the risk of conversion to psychosis. An economic model from the Canadian health system perspective was developed to evaluate the cost-effectiveness of treating all with UHR compared to risk stratification over a 15-year time horizon, based on conversion probability, expected quality-of-life and costs. The analysis used a decision tree followed by a Markov model. Health states included: Not UHR, UHR with <20 % risk of conversion to FEP (based on the North American Prodrome Longitudinal Study risk calculator), UHR with =20 % risk, FEP, Remission, Post-FEP, and Death. The analysis found that: risk stratification (i.e., only treating those with =20 % risk) had lower costs ($1398) and quality-adjusted life-years (0.055 QALYs) per person compared to treating all. The incremental cost-effectiveness ratio for ‘treat all’ was $25,448/QALY, and suggests treating all may be cost-effective. The model was sensitive to changes to the probability of conversion.
AB - People who are at ultra-high risk (UHR) for psychosis receive clinical care with the aim to prevent first-episode psychosis (FEP), regardless of the risk of conversion to psychosis. An economic model from the Canadian health system perspective was developed to evaluate the cost-effectiveness of treating all with UHR compared to risk stratification over a 15-year time horizon, based on conversion probability, expected quality-of-life and costs. The analysis used a decision tree followed by a Markov model. Health states included: Not UHR, UHR with <20 % risk of conversion to FEP (based on the North American Prodrome Longitudinal Study risk calculator), UHR with =20 % risk, FEP, Remission, Post-FEP, and Death. The analysis found that: risk stratification (i.e., only treating those with =20 % risk) had lower costs ($1398) and quality-adjusted life-years (0.055 QALYs) per person compared to treating all. The incremental cost-effectiveness ratio for ‘treat all’ was $25,448/QALY, and suggests treating all may be cost-effective. The model was sensitive to changes to the probability of conversion.
KW - Cost-benefit analysis
KW - Costs and cost analysis
KW - Health care costs
KW - Prodromal symptoms
KW - Psychotic disorders
KW - Quality-adjusted life years
KW - Schizophrenia
U2 - 10.1016/j.schres.2023.09.015
DO - 10.1016/j.schres.2023.09.015
M3 - Article
SN - 0920-9964
VL - 261
SP - 225
EP - 233
JO - Schizophrenia Research
JF - Schizophrenia Research
IS - 1
ER -