A Systematic Review of Economic Models Across the Entire Schizophrenia Pathway

Abstract

Background: Schizophrenia is associated with a high economic burden. Economic models can help to inform resource allocation decisions to maximise benefits to patients.Objectives: This systematic review aims to assess the availability, quality and consistency of conclusions of health economic models evaluating the cost-effectiveness of interventions for schizophrenia. Methods: An electronic search was performed on multiple databases (MEDLINE, EMBASE, PsycInfo, Cochrane database of systematic reviews, NHS Economic Evaluation Database and Health Technology Assessment database) to identify economic models of interventions for schizophrenia published between 2005-2020. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) checklist and the Cooper hierarchy. Model characteristics and conclusions were descriptively summarised. Results: Seventy-three models met inclusion criteria. 78% of existing models assessed antipsychotics, however, due to inconsistent conclusions reported by different studies, no antipsychotic can be considered clearly costeffective compared with the others. A very limited number of models suggest that the following nonpharmacological interventions might be cost-effective: psychosocial interventions, stratified tests, employment intervention and intensive intervention to improve liaison between primary and secondary care. The quality of included models is generally low due to use of a short time horizon, omission of adverse events of interventions, poor data quality and potential conflicts of interest.Conclusions: This review highlights a lack of models for non-pharmacological interventions, and limitations of the existing models, including low quality and inconsistency in conclusions. Recommendations on future modelling approaches for schizophrenia are provided. Key Points for Decision Makers• This is the first systematic review of model-based economic analyses which covers the entire schizophrenia care pathway, by including any intervention for the prevention, detection, diagnosis, treatment and follow-up of schizophrenia.• This review highlights a lack of models for non-pharmacological interventions, and low quality of existing models. Common reasons for low-quality include use of a time-horizon which is not sufficiently long, failure to capture the health and cost impact of adverse events of the interventions under assessment, and potential conflicts of interest.• Due to inconsistent conclusions reported by different studies, no antipsychotic can be considered clearly cost-effective compared with the others. A very limited number of models suggest that the following non-pharmacological interventions might be cost-effective: psychosocial interventions, stratified tests, employment intervention and intensive intervention to improve liaison between primary and secondary care.• A consistent basis for the model structure, use of evidence and assumptions in health economic models is required in order to i...

Overview and Use of Tools for Selecting Modelling Techniques in Health Economic Studies

“…Given the volume of literature reporting health economic models in all disease areas, it was not feasible to consider the value of applying model selection tools to all published health economic models. Instead, we used a convenience sample of health economic models taken from a systematic review we recently conducted of health economic models which assessed the cost-effectiveness of interventions for people with schizophrenia, including both pharmacological and non-pharmacological interventions [23]. Of the 64 health economic models identified by the systematic review, 53 models assessed antipsychotic medications and these were used as a case study to explore the use of model selection tools.…”

“…Review of citations of the identified model selection tools found that the seven tools were only cited 126 times by model-based health economic evaluations. This number is very small, given the total number of health economic models that are developed, for instance, for a single disease there are 73 for schizophrenia [23] and over 100 for diabetes [49]. The most commonly cited tool was the Brennan's toolkit [2] (50.0%).…”

Evaluation of the Cost-effectiveness of Services for Schizophrenia in the UK Across the Entire Care Pathway in a Single Whole-Disease Model

“…1 A 2020 systematic review found several limitations of existing economic models for schizophrenia. 2 Most existing models (83%) focused on antipsychotic medications, while there was a lack of models for nonpharmacologic interventions, such as cognitive behavioral therapy (CBT), family intervention, and crisis resolution and home treatment team (CRHT). Second, no antipsychotic medication was shown to be clearly cost-effective compared with the others because of inconsistent or even contradictory conclusions reported by different studies.…”

Systematic review of the methods of health economic models assessing antipsychotic medication for schizophrenia

“…If important impacts of an intervention are omitted, the model results will be flawed and resource allocation decisions may be incorrect [ 13 ], with potential consequences including wasted resources in the healthcare system and quality of life and survival losses in the population concerned. Several systematic reviews [ 7 , 14 – 18 ] have been conducted for economic evaluations of antipsychotic medications for people with schizophrenia, and they all reported inconsistency in conclusions reported by different models. However, none of the published systematic reviews explored and compared the key clinical and cost impacts of antipsychotic medications considered by existing models.…”