Risk stratification for treating people at ultra-high risk for psychosis: A cost-effectiveness analysis

Olajumoke M Ologundudu; Lena Palaniyappan; Lauren E Cipriano; Ben F M Wijnen; Kelly K Anderson; Shehzad Ali

doi:10.1016/j.schres.2023.09.015

Risk stratification for treating people at ultra-high risk for psychosis: A cost-effectiveness analysis

Schizophr Res. 2023 Nov:261:225-233. doi: 10.1016/j.schres.2023.09.015. Epub 2023 Oct 5.

Authors

Olajumoke M Ologundudu¹, Lena Palaniyappan², Lauren E Cipriano³, Ben F M Wijnen⁴, Kelly K Anderson⁵, Shehzad Ali⁶

Affiliations

¹ Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
² Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
³ Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Ivey Business School, Western University, London, Ontario, Canada.
⁴ Centre of Economic Evaluation (Trimbos Institute), Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands.
⁵ Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
⁶ Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Health Sciences, University of York, United Kingdom; Department of Psychology, Macquarie University, Australia. Electronic address: shehzad.ali@uwo.ca.

PMID: 37804598
DOI: 10.1016/j.schres.2023.09.015

Abstract

People who are at ultra-high risk (UHR) for psychosis receive clinical care with the aim to prevent first-episode psychosis (FEP), regardless of the risk of conversion to psychosis. An economic model from the Canadian health system perspective was developed to evaluate the cost-effectiveness of treating all with UHR compared to risk stratification over a 15-year time horizon, based on conversion probability, expected quality-of-life and costs. The analysis used a decision tree followed by a Markov model. Health states included: Not UHR, UHR with <20 % risk of conversion to FEP (based on the North American Prodrome Longitudinal Study risk calculator), UHR with ≥20 % risk, FEP, Remission, Post-FEP, and Death. The analysis found that: risk stratification (i.e., only treating those with ≥20 % risk) had lower costs ($1398) and quality-adjusted life-years (0.055 QALYs) per person compared to treating all. The incremental cost-effectiveness ratio for 'treat all' was $25,448/QALY, and suggests treating all may be cost-effective. The model was sensitive to changes to the probability of conversion.

Keywords: Cost-benefit analysis; Costs and cost analysis; Health care costs; Prodromal symptoms; Psychotic disorders; Quality-adjusted life years; Schizophrenia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
Cost-Effectiveness Analysis*
Humans
Longitudinal Studies
Psychotic Disorders* / therapy
Risk Assessment

Grants and funding

153022/CIHR/Canada