1
|
Shields GE, Buck D, Varese F, Yung AR, Thompson A, Husain N, Broome MR, Upthegrove R, Byrne R, Davies LM. A review of economic evaluations of health care for people at risk of psychosis and for first-episode psychosis. BMC Psychiatry 2022; 22:126. [PMID: 35177010 PMCID: PMC8851734 DOI: 10.1186/s12888-022-03769-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Preventing psychotic disorders and effective treatment in first-episode psychosis are key priorities for the National Institute for Health and Care Excellence. This review assessed the evidence base for the cost-effectiveness of health and social care interventions for people at risk of psychosis and for first-episode psychosis. METHODS Electronic searches were conducted using the PsycINFO, MEDLINE and Embase databases to identify relevant published full economic evaluations published before August 2020. Full-text English-language studies reporting a full economic evaluation of a health or social care intervention aiming to reduce or prevent symptoms in people at risk of psychosis or experiencing first-episode psychosis were included. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms based on the NHS Economic Evaluation Database (EED) handbook and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist for economic evaluations. The protocol was registered on the PROSPERO database (CRD42018108226). Results were summarised qualitatively. RESULTS Searching identified 1,628 citations (1,326 following the removal of duplications). After two stages of screening 14 studies met the inclusion criteria and were included in the review. Interventions were varied and included multidisciplinary care, antipsychotic medication, psychological therapy, and assertive outreach. Evidence was limited in the at-risk group with only four identified studies, though all interventions were found to be cost-effective with a high probability (> 80%). A more substantial evidence base was identified for first-episode psychosis (11 studies), with a focus on early intervention (7/11 studies) which again had positive conclusions though with greater uncertainty. CONCLUSIONS Study findings generally concluded interventions were cost-effective. The evidence for the population who are at-risk of psychosis was limited, and though there were more studies for the population with first-episode psychosis, limitations of the evidence base (including generalisability and heterogeneity across the methods used) affect the certainty of conclusions.
Collapse
Affiliation(s)
- Gemma E. Shields
- grid.5379.80000000121662407Manchester Centre for Health Economics, Division of Population Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Deborah Buck
- grid.5379.80000000121662407Manchester Centre for Health Economics, Division of Population Health, School of Health Sciences, University of Manchester, Manchester, UK ,grid.83440.3b0000000121901201Institute of Education, University College London, London, UK
| | - Filippo Varese
- grid.5379.80000000121662407Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK ,grid.507603.70000 0004 0430 6955Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R. Yung
- grid.5379.80000000121662407Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK ,grid.507603.70000 0004 0430 6955Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia ,grid.1021.20000 0001 0526 7079Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Andrew Thompson
- grid.1008.90000 0001 2179 088XOrygen, The Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia ,grid.7372.10000 0000 8809 1613Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK
| | - Nusrat Husain
- grid.5379.80000000121662407Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Matthew R. Broome
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,grid.498025.20000 0004 0376 6175Birmingham Early Intervention Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Rachel Upthegrove
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,grid.498025.20000 0004 0376 6175Birmingham Early Intervention Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Rory Byrne
- grid.507603.70000 0004 0430 6955Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Linda M. Davies
- grid.5379.80000000121662407Manchester Centre for Health Economics, Division of Population Health, School of Health Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
2
|
Wang L, Shi F, Guan X, Xu H, Liu J, Li H. A Systematic Review of Methods and Study Quality of Economic Evaluations for the Treatment of Schizophrenia. Front Public Health 2021; 9:689123. [PMID: 34746073 PMCID: PMC8564012 DOI: 10.3389/fpubh.2021.689123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023] Open
Abstract
Background: Schizophrenia is a severe and complex disease with substantial economic and social burdens. Despite multiple treatment choices, adverse events, and impaired social functions are still challenges in clinical therapy. Pharmacoeconomic evaluations could provide evidence to help decision makers improve the utilization of scarce resources. However, there remains some challenges especially in modeling due to uncertainties in progression of schizophrenia. There are limited summaries about the overall methodologies of schizophrenia economic evaluations. Objective: The aim of this study is to review the existing economic evaluations of antipsychotics for the treatment of schizophrenia and summarize the evidence and methods applied. Methods: An electronic literature search was performed in PubMed, Web of Science, EBSCO host, The Cochrane Library and ScienceDirect from January 2014 to December 2020. Search terms included “schizophrenia,” “schizophrenic,” “pharmacoeconomic,” “economic evaluation,” “cost-effectiveness,” and “cost-utility.” The Literature was screened and extracted by two researchers independently and assessed with the Quality of Health Economic Studies (QHES) List and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement. Results: A total of 25 studies were included in the review. The regions included Europe, North America, Asia and Africa. Most of the studies chose second-generation antipsychotics as comparators and integrated treatment sequences. Time horizons varied from 1 year to lifetime. The healthcare sector was the most common perspective, accordingly, most of the evaluations considered only direct medical costs. The Markov model and decision tree model were the most common choices. Adverse events, compliance and persistence were considered important parameters. Quality-adjusted life-years were the major outcomes applied to the economic evaluations. All utilities for health states and adverse events were collected from published literature. All of the studies applied uncertainty analysis to explore the robustness of the results. The quality of the studies was generally satisfactory. However, improvements were needed in the choice of time horizons, the measurements of outcomes and the descriptions of assumptions. Conclusions: This study highlights the methodology of economic evaluation of schizophrenia. Recommendations for modeling method and future study are provided.
Collapse
Affiliation(s)
- Luying Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Fenghao Shi
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Xin Guan
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - He Xu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Jing Liu
- Sumitomo Pharma (Suzhou) Co., Ltd., Shanghai, China
| | - Hongchao Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| |
Collapse
|