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Cost-effectiveness of early intervention services for psychosis

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Background/Objectives: Early intervention (EI) for psychosis has been shown to reduce healthcare costs. Key aims of many EI services are to maintain people in employment, education or training or to enable recovery in these areas. Clearly there are economic benefits to be attained for individuals themselves from this in terms of increased income, but also to society as a result of increased production. Psychosis can also have devastating effects for the patient and others. Suicide rates are high and these frequently take place early in the illness. Some people with psychosis will commit offences as a result of their illness. Some offences may be common but have a low cost, whilst high cost offences occur less frequently. The objective of this study is to estimate the impact on costs of lost employment, suicide and homicide. Methods: Decision models were constructed with data obtained from published sources where available. Expected costs for EI and standard care in the above areas were estimated and sensitivity analyses conducted. Results: EI results in substantially reduced costs of lost employment. This is due to estimated employment rates of 36% and 27% for EI and standard care respectively. Using a minimum wage rate the average savings are £ 2087. The cost of homicide is low for both EI and standard care. However, for EI the annual costs of homicide (£ 6 per person) are £ 80 per person lower than for standard care (£ 86 per person). Suicide is assumed to occur for 1.3% of EI patients and 4% of standard care patients. The estimated annual saving in suicide costs due to EI is £ 957 per person. Discussion/Conclusions: This paper reinforces findings from earlier work that shows EI to be a potentially cost-saving way of providing care to those in an early stage of psychosis. There is much uncertainty around costs of suicide and homicide, but the data shown here suggest that the contribution they make to total costs is limited. EI has the potential to reduce health care costs and also the costs of lost employment, suicide and homicide.

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