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Team-based coordinated care more cost-effective for first-episode psychosis

Coordinated specialty care was more cost-effective than typical community care for young individuals with first-episode psychosis, according to findings from the Recovery After an Initial Schizophrenia Episode (RAISE) initiative.

To assess cost-effectiveness of coordinated specialty care in the RAISE Early Treatment Program, Robert Rosenheck, MD, of Yale University, and colleagues compared NAVIGATE, a team-based psychotherapy program, with typical care at clinics among 404 individuals with first-episode psychosis.

NAVIGATE includes a team of specialists offering psychotherapy, low-dose antipsychotic medications, family education and support, case management, and work or education support.

Rosenheck and colleagues found that the NAVIGATE group received significantly more intensive mental health outpatient services compared with those receiving typical care. Individuals receiving NAVIGATE received 61% more days of rehabilitative services for work or education support and six times as many meetings with families to establish a shared understanding of illness and treatment, compared with those receiving typical care.

Overall, individuals receiving NAVIGATE had health care costs 27% greater than individuals who received typical care.

Extra costs were associated with increased time with health care professionals, specialized training for clinicians and staff, and a computer program designed to help physicians choose ideal medication regimens often recommended newer, brand-name drugs without generic equivalents.

Analysis indicated the duration of untreated psychosis, or time between psychotic symptom onset and treatment initiation, was significantly associated with program effectiveness and cost.

Half of the study cohort had a duration of untreated psychosis less than 74 weeks.

Individuals with shorter duration of untreated psychosis who received NAVIGATE had greater improvement in quality of life and lower costs, due to reduced use of hospital services, according to researchers.

Average annual costs of NAVIGATE among individuals with shorter duration of untreated psychosis were 15% lower than annual costs of typical care.

“The take-home message of this sophisticated research is that health service costs are, not surprisingly, somewhat higher when the mental health system provides the full range of services these young people need at a very vulnerable time in their lives,” Robert K. Heinssen, PhD, director of the Division of Services and Intervention Research at NIMH, said in a press release. “But these additional expenses have now been shown to be worth the investment in improving individuals’ health and functioning.” – by Amanda Oldt

Disclosure: Please see the full study for a list of all authors’ relevant financial disclosures.