The Danish OPUS Early Intervention Services for First-Episode Psychosis: A Phase 4 Prospective Cohort Study With Comparison of Randomized Trial and Real-World Data

Posselt, Christine Merrild; Albert, Nikolai; Nordentoft, Merete; Hjorthøj, Carsten

doi:10.1176/appi.ajp.2021.20111596

Cited by 16 publications

(10 citation statements)

References 31 publications

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“…However, the generalizability of the trial results to current Canadian practice is unknown. In addition, RCTs may have had higher standards of fidelity than real world practices of EPI although the recent OPUS-real-world 38 data confirmed the effectiveness of EPI in real-world settings. We also did not model the costs and monetized benefits of providing EPI beyond 2 years.…”

Section: Discussionmentioning

confidence: 99%

Economic Evaluation of Early Psychosis Interventions From A Canadian Perspective

et al. 2022

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Background Compared to treatment as usual (TAU), early psychosis intervention programs (EPI) have been shown to reduce mortality, hospitalizations and days of assisted living while improving employment status. Aims The study aim was to conduct a cost-benefit analysis (CBA) and a cost-effectiveness analysis (CEA) to compare EPI and TAU in Canada. Methods A decision-analytic model was used to estimate the 5-year costs and benefits of treating patients with a first episode of psychosis with EPI or TAU. EPI benefits were derived from randomized controlled trials (RCTs) and Canadian administrative data. The cost of EPI was based on a published survey of 52 EPI centers in Canada while hospitalizations, employment and days of assisted living were valued using Canadian unit costs. The outcomes of the CBA and CEA were expressed in terms of net benefit (NB) and incremental cost per life year gained (LYG), respectively. Scenario analyses were conducted to examine the impact of key assumptions. Costs are reported in 2019 Canadian dollars. Results Base case results indicated that EPI had a NB of $85,441 (95% CI: $41,140; $126,386) compared to TAU while the incremental cost per LYG was $26,366 (95% CI: EPI dominates TAU (less costs, more life years); $102,269). In all sensitivity analyses the NB of EPI remained positive and the incremental cost per LYG was less than $50,000. Conclusions In addition to EPI demonstrated clinical benefits, our results suggest that large-scale implementation of EPI in Canada would be desirable from an economic point of view .

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Section: Discussionmentioning

confidence: 99%

Economic Evaluation of Early Psychosis Interventions From A Canadian Perspective

et al. 2022

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“…This study aimed to establish the naturalistic treatment trajectories of young people accessing these services outside the setting of a structured research project with the associated sample bias (Posselt et al, 2021). The improvement seen in functional outcomes across the course of care provides face validity to recovery orientated treatment programmes.…”

Section: Discussionmentioning

confidence: 99%

“…However, as less than half of those accessing services consented to take part in the data collection for the project, the data analysed may not be representative of the broader population of service users. A more recent analysis of real-world implementation of FEP services (Posselt et al, 2021) focused on outcomes obtained from Danish national registries with the authors comparing these findings to similar outcome measures from the original Danish OPUS trial (Petersen et al, 2005). They reported improved outcomes for individuals who received treatment after implementation of FEP services nationally, including fewer and shorter psychiatric admissions and higher rates of employment.…”

Section: Introductionmentioning

confidence: 99%

The clinical and functional outcomes of a large naturalistic cohort of young people accessing national early psychosis services

Brown

Gao

Staveley

et al. 2021

Aust N Z J Psychiatry

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Aims: Services for individuals with a first episode of psychosis or at ultra-high risk of psychosis have become a treatment model of choice in mental health care. The longitudinal changes in clinical and functional outcomes as a result of real-world treatment remain under-reported. Methods: We analysed data from first episode of psychosis and ultra-high risk services delivered across Australian primary youth mental health care services known as headspace between 19 June 2017 and 30 September 2019. Outcome measures were completed and entered into a minimum dataset every 90 days a participant was receiving treatment and included psychiatric symptomatology (Brief Psychiatric Rating Scale and psychological distress, K10) and psychosocial functioning (Social and Occupational Functioning Assessment Scale and My Life Tracker). Linear mixed-effects models were used to evaluate changes in outcome over time. Results: Outcome data from a total of 1252 young people were evaluated (643 first episode of psychosis, 609 ultra-high risk). Of those who entered ultra-high risk services, 11.8% transitioned to first episode of psychosis services. Overall, substantial improvement in clinical (Brief Psychiatric Rating Scale, K10) and functional (Social and Occupational Functioning Assessment Scale, My Life Tracker) outcomes were seen across groups and outcomes. Ultra-high risk patients showed a greater reduction in distress symptoms, while first episode of psychosis patients experienced a greater reduction in positive psychosis symptoms. Although clinical outcomes showed a plateau effect after approximately 3 months of care, improvement in functional outcomes (Social and Occupational Functioning Assessment Scale, My Life Tracker) continued later in treatment. Conclusion: These findings support the use of real-time, real-world and low-cost administrative data to rigorously evaluate symptomatic and functional outcomes in early psychosis treatment settings. Findings that functional outcomes improve past the remittance of clinical outcomes also support the functional recovery focus of early psychosis services and remaining high levels of distress suggest the need for ultra-high risk services to extend beyond 6 months of care.

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“…The clinical benefits and cost-effectiveness of team-based first episode psychosis services have been demonstrated (Aceituno et al, 2019;Correll et al, 2018;Rosenheck et al, 2016). Implementation of early psychosis services outside of randomized controlled studies has shown encouraging results (Posselt et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…The clinical benefits and cost‐effectiveness of team‐based first episode psychosis services have been demonstrated (Aceituno et al, 2019; Correll et al, 2018; Rosenheck et al, 2016). Implementation of early psychosis services outside of randomized controlled studies has shown encouraging results (Posselt et al, 2021). Successful implementation of evidence‐based practices requires the alignment of a complex set of processes, with identification and measurement of the core components identified in research (Damschroder et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

A comparison of the National Clinical Audit of Psychosis 2019/2020 standards and First Episode Psychosis Services Fidelity Scale 1.0

Addington

French

Smith

2021

Early Intervention Psych

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Aim The authors compare two approaches to assessment of the quality of early psychosis intervention services, the National Clinical Audit of Psychosis used in the United Kingdom and the First Episode Psychosis Services Fidelity Scale used in North America and Europe. Methods We compare the two approaches on the source of standards, measurement type, data collection, time requirements, scoring and reliability. Finally, we review their strengths and limitations. Results Both measures are based on standards derived from the same research evidence base. Both methods rely on data from health records and administrative data. The audit is supplemented with user survey data, the fidelity scale with clinician interviews. The audit requires more time. The audit is based on quality indicators rated as present or absent which yields a statistical benchmark. The Fidelity Scale is based on quality indicators that are rated on a five‐point scale yielding a standards‐based measure. The two methods cover similar service components, but the FEPS‐FS has a broader coverage of team functioning. The National audit also collects data on the user experience directly from patients. The fidelity scale has achieved good to excellent inter‐rater reliability, the reliability of the audit has not been tested. Conclusions Both methods have face validity and provide reliable and useful measures of quality of care. The NCAP works in the context of a single provider health system, the FEPS‐FS works in a more variable health system. Comparing the two systems in the field would support international comparison of standards of care.

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The Danish OPUS Early Intervention Services for First-Episode Psychosis: A Phase 4 Prospective Cohort Study With Comparison of Randomized Trial and Real-World Data

Cited by 16 publications

References 31 publications

Economic Evaluation of Early Psychosis Interventions From A Canadian Perspective

Economic Evaluation of Early Psychosis Interventions From A Canadian Perspective

The clinical and functional outcomes of a large naturalistic cohort of young people accessing national early psychosis services

A comparison of the National Clinical Audit of Psychosis 2019/2020 standards and First Episode Psychosis Services Fidelity Scale 1.0

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