Limitations
Several limitations of this study require comment. First, the conditions of a randomized trial like RAISE-ETP may not be generalizable to real-world practice since all sites that volunteered for RAISE-ETP were capable and motivated to successfully implement a comprehensive, integrated care FEP program with existing non-research sources of funding. As a result, CC sites most likely offered a level of FEP care that was superior to usual FEP treatment in the US, thus minimizing observed differences between NAV and usual treatment. In several other RCTs of FEP programs, rates of hospitalization among control groups were 37% to 71% over 12 months, 1.5 to 3.5 times greater than the 20% seen in the first 12 months for CC in this study. This difference suggests that the lack of more favorable NAV-CC differences in inpatient care and costs may reflect an exceptionally good performance at keeping hospital utilization low at CC sites in this study. If CC subjects in the present study had performed similarly to control groups in previous trials cited above, the differentially greater costs associated with NAV might have been reduced to zero or might even have been reversed to as much as $7000 in savings. Generalizability of these results is thus uncertain as RAISE-ETC may have artificially increased CC effectiveness and reduced CC costs….
by Robert Rosenheck, Douglas Leslie, Kyaw Sint, Haiqun Lin, Delbert C. Robinson, Nina R. Schooler, Kim T. Mueser, David L. Penn,, Jean Addington, Mary F. Brunette, Christoph U Correll, Sue E. Estroff, Patricia Marcy, James Robinson, Joanne Severe, Agnes Rupp, Michael Schoenbaum, and John M. Kane.Schizophrenia Bulletin. Advance Access 01/31/2016.
This study compares the cost-effectiveness of Navigate [NAV], a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis [FEP] and usual Community Care [CC] in a cluster randomization trial. Patients at 34 community treatment clinics were randomly assigned to either NAV [N = 223] or CC [N = 181] for 2 years. Effectiveness was measured as a one standard deviation change on the Quality of Life Scale [QLS-SD]. Incremental cost effectiveness ratios were evaluated with bootstrap distributions. The Net Health Benefits Approach was used to evaluate the probability that the value of NAV benefits exceeded its costs relative to CC from the perspective of the health care system. The NAV group improved significantly more on the QLS and had higher outpatient mental health and antipsychotic medication costs. The incremental cost-effectiveness ratio was $12 081/QLS-SD, with a .94 probability that NAV was more cost-effective than CC at $40 000/QLS-SD. When converted to monetized Quality Adjusted Life Years, NAV benefits exceeded costs, especially at future generic drug prices.
NIH-funded study shows early intervention is more cost-effective than typical careNIMH: Press ReleaseFebruary 1, 2016New analysis from a mental health care study shows that “coordinated specialty care” [CSC] for young people with first episode psychosis is more cost-effective than typical community care. Cost-effectiveness analysis in health care is a way to compare the costs and benefits of two or more treatment options. While the team-based CSC approach has modestly higher costs than typical care, it produces better clinical and quality of life outcomes, making the CSC treatment program a better value. These findings of this study, funded by the National Institute of Mental Health, part of the National Institutes of Health, will help guide mental health professionals in their treatment for first episode psychosis.
This new analysis, published online today by Schizophrenia Bulletin, was led by Robert Rosenheck, M.D. , professor of psychiatry and public health at Yale University. It is part of the Recovery After an Initial Schizophrenia Episode initiative also funded by the National Institute of Mental Health. This paper reported on the cost-effectiveness of CSC treatment in the RAISE Early Treatment Program , a randomized controlled trial headed by John M. Kane, M.D ., professor and chairman, Department of Psychiatry at The Hofstra North Shore-LIJ School of Medicine and The Zucker Hillside Hospital.
Coordinated specialty care for first episode psychosis is a team-based treatment program tailored to each individual that involves more specialty care from mental health providers than typical care. Dr. Rosenheck and colleagues focused on a specific CSC program, called NAVIGATE, which featured a team of specialists offering recovery-oriented psychotherapy, low-dose antipsychotic medications, family education and support, case management, and work or education support…
Well, those are all the words, at least the ones I know about. Here’s the music. Anybody reading this knows that we badly need stable programs for people with psychotic illness, particularly First Episode Psychosis. I expect that most people reading this feel that the skillful use of antipsychotic medication is part of that treatment for many. I expect most would agree that there needs to be a place in those programs for people who won’t or don’t need to take medication. Many would agree that there needs to be a provision for actively psychotic people who are out of control or dangerous other than prison. And most accept that the care needed is a humanitarian responsibility of society. I expect that people who think it’s all a medication issue or all a psychotherapy issue aren’t reading this.
“This scientific work is having an immediate impact on clinical practice in the United States and is setting a new standard of care,” added Heinssen. “We’re seeing more states adopt coordinated specialty care programs for first episode psychosis, offering hope to thousands of clients and family members who deserve the best care that science can deliver.”
Well, another RAISE paper which doesn’t discuss medication doses! Curious considering that this aspect of the study was mentioned in the original NIMH press release.
In fact the cost of antipsychotics was higher in the intervention group in this study, even assuming generic drug prices ($137 per 6 months, vs $102 in usual care). This doesn’t mean doses were higher because it might be that the intervention group used more expensive drugs, or formulations (e.g. depot injections). But it would be interesting to know what the doses were!
Amen,
“it would be interesting to know” almost anything specific!