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

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Radhakrishnan, Muralikrishnan, McCrone, Paul, Lafortune, Louise, Everard, Linda, Fowler, David, Amos, Tim, Freemantle, Nick, Singh, Swaran P., Marshall, Max, Sharma, Vimal, Lavis, Anna, Jones, Peter B. and Birchwood, M. J. (2018) Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance. Early Intervention in Psychiatry, 12 (4). pp. 747-756. doi:10.1111/eip.12481 ISSN 1751-7885.

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Official URL: http://dx.doi.org/10.1111/eip.12481

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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.

Item Type: Journal Article
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title: Early Intervention in Psychiatry
Publisher: Wiley-Blackwell Publishing Ltd.
ISSN: 1751-7885
Official Date: August 2018
Dates:
DateEvent
August 2018Published
31 August 2017Available
11 July 2017Accepted
Volume: 12
Number: 4
Page Range: pp. 747-756
DOI: 10.1111/eip.12481
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access

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