Designing and Testing of a Health-Economic Markov Model for Prevention and Treatment of Early Psychosis

Wijnen, Ben; Thielen, Frederick W.; Konings, S; Feenstra, Talitha; Gaag, Mark van der; Veling, Wim; Haan, Lieuwe de; Ising, Helga K.; Hiligsmann, Mickaël; Evers, Silvia M. A. A.; Smit, Filip; Lokkerbol, Joran

doi:10.1080/14737167.2019.1632194

Cited by 12 publications

(49 citation statements)

References 55 publications

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“…In terms of population, the majority of included studies related to people with a diagnosis of schizophrenia (68/73, 93.2%). The remaining studies evaluated interventions for people with a non-specific diagnosis of psychosis (5/73, 6.8%) [1,[15][16][17][18] and those at CHR (2/73, 2.7%) [15,17]. In terms of interventions assessed, most included studies compared the costeffectiveness of different antipsychotics versus each other, placebo or nothing (57/73, 78.1%).…”

Section: Study Descriptionsmentioning

confidence: 99%

“…In terms of interventions assessed, most included studies compared the costeffectiveness of different antipsychotics versus each other, placebo or nothing (57/73, 78.1%). The remaining studies assessed the cost-effectiveness of different coverage of Medicare drug plans (1/53, 1.6%) [19], electroconvulsive therapy (ECT) versus antipsychotic (1/53, 1.6%) [20], precision medicine test versus no test (4/73, 5.5%) [21][22][23][24], different monitoring schedules for patients receiving clozapine (1/73, 1.4%) [25], antipsychotics versus antipsychotics plus psychosocial interventions (5/73, 6.8%) [26][27][28][29][30], CBT versus no CBT (1/73, 1.4%) [17], improving patients' access to psychological therapies versus no intervention (1/73, 1.4%) [18], supported employment programme vs no intervention (1/73, 1.4%) [1], and different modes of liaison between primary and secondary care services (1/53, 1.6%) [15]. The availability of economic evidence across the schizophrenia care pathway is presented in Fig.…”

Section: Study Descriptionsmentioning

confidence: 99%

“…Healthcare system and social care 8 (11.0) 1: Two studies [15,17] included two groups of people: people at CHR and people with non-specific diagnosis of psychosis.…”

Section: Perspective Of Costmentioning

confidence: 99%

“…According to the quality assessment results of the NICE checklist, sixty-two studies were deemed to have very serious limitations (84.9%), eight were deemed to have potentially serious limitations (11.0%), and three were deemed to have minor limitations (4.1%) [1,17,31]. The performance of included studies on all items of the NICE checklist is shown in Fig.…”

Section: Nice Checklistmentioning

confidence: 99%

“…Patients with ultra-high risk of developing psychosis or with FEP 1 Netherland (1/1, 100.0%) [17] Minor limitations (1/1, 100.0%) [17] The Netherlandish study [17] reported that care as usual plus CBT dominates care as usual.…”

Section: Cbt Versus No Cbtmentioning

confidence: 99%

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A Systematic Review of Economic Models Across the Entire Schizophrenia Pathway

et al. 2020

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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...

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Section: Study Descriptionsmentioning

confidence: 99%

Section: Study Descriptionsmentioning

confidence: 99%

“…Healthcare system and social care 8 (11.0) 1: Two studies [15,17] included two groups of people: people at CHR and people with non-specific diagnosis of psychosis.…”

Section: Perspective Of Costmentioning

confidence: 99%

Section: Nice Checklistmentioning

confidence: 99%

Section: Cbt Versus No Cbtmentioning

confidence: 99%

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A Systematic Review of Economic Models Across the Entire Schizophrenia Pathway

et al. 2020

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Exploring the effectiveness of family-based interventions for psychosis in low- and middle-income countries: a systematic review

Morillo

Lowry

Henderson

2022

Soc Psychiatry Psychiatr Epidemiol

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Purpose Of the 80% people with psychosis living in low- and middle-income countries (LMICs), up to 90% are left to the care of families. The World Health Organization has recommended the inclusion of families in community-based rehabilitation and while there is evidence of its implementation in LMICs, this has not been reviewed yet. This study aims to describe the key features and implementation strategies of family-based interventions in LMICs, and appraise their effectiveness. Methods Included are people with psychosis in LMICs who receive any form of family-based intervention, compared to their usual or absence of treatment, with patient outcome measures. We searched (August 2021) through Embase, MEDLINE, Global Health, PsycInfo, Social Policy and Practice, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as from grey literature and hand-searched records. Risk of bias was assessed through the Integrated Quality Criteria for Review of Multiple Study Designs (ICROMS) and Consolidated Health Economic Evaluation Reporting Standards (CHEERS), then analyzed narratively. Results 27 studies were included from the 5254 records. Psychotherapeutic features, systems approach and task-sharing were key intervention elements. Delivery strategies included preliminary research, sustained family engagement, and cultural adaptation. There were positive health impacts across four outcome domains. Conclusion All studies recommended family-based interventions, with limitations in heterogeneity and 70% of them rated high risk of bias. Other Review was registered in PROSPERO (CRD42021256856). The authors did not receive funding for this research.

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