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
PY - 2023/11
Y1 - 2023/11
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
UR - http://www.scopus.com/inward/record.url?scp=85173233111&partnerID=8YFLogxK
U2 - 10.1016/j.schres.2023.09.015
DO - 10.1016/j.schres.2023.09.015
M3 - Article
C2 - 37804598
AN - SCOPUS:85173233111
SN - 0920-9964
VL - 261
SP - 225
EP - 233
JO - Schizophrenia Research
JF - Schizophrenia Research
ER -