Abstract
BackgroundA combination of psychosocial interventions and medications has been highly recommended as a successful treatment package for schizophrenia. Its cost-effectiveness has not been fully explored yet. The aim of the present analysis was to evaluate the cost-effectiveness of antipsychotics combined with psychosocial treatment and treatment as usual for patients with early-stage schizophrenia.MethodPatients with schizophrenia (N = 1, 268) were assigned to the combination of medication and psychosocial intervention or treatment as usual for up to 12 months. Cost analysis included direct medical costs, direct nonmedical costs and indirect costs. Quality-adjusted life year (QALY) ratings were assessed with Short- Form 6D.ResultsAverage monthly psychosocial intervention costs for combined treatment were higher than treatment as usual (p = 0.005), but no significant differences were found in direct costs, indirect costs, and total costs between two groups (all p-values ≥ 0.556). Combined treatment was associated with significant higher QALY ratings than treatment as usual (p = 0.039). Compared with treatment as usual, combined treatment resulted in a gain of 0.031 QALY ratings at an additional cost of US$ 56.4, yielding an incremental cost-effectiveness ratio of US$ 1819.4 per QALY gained.ConclusionsDespite some limitations, our results supported that medication combined with psychosocial treatment was more cost-effective than treatment as usual for patients with early-stage schizophrenia.Trial registrationclinicaltrials.gov Identifier: NCT00654576Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0212-0) contains supplementary material, which is available to authorized users.
Highlights
A combination of psychosocial interventions and medications has been highly recommended as a successful treatment package for schizophrenia
Average monthly psychosocial intervention costs for combined treatment were higher than treatment as usual (p = 0.005), but no significant differences were found in direct costs, indirect costs, and total costs between two groups
Compared with treatment as usual, combined treatment resulted in a gain of 0.031 Quality-adjusted life year (QALY) ratings at an additional cost of US$ 56.4, yielding an incremental cost-effectiveness ratio of US$ 1819.4 per QALY gained
Summary
Participants Altogether, 1268 participants entered the study, 633 were assigned to receive antipsychotics combined with psychosocial intervention (of whom 29 refused the psychosocial intervention) and 635 to receive treatment as usual. There were no significant differences between study groups with respect to baseline demographic and clinical characteristics (all p-values ≥ 0.057). Average monthly psychosocial intervention costs were higher for combined treatment than treatment as usual (p = 0.005), but no significant differences were found in direct costs, indirect costs, and total costs between two groups (all p-values ≥ 0.556). Differences between two treatment groups were observed in FBS total scores and SF-36 the Physical Component Score (PCS) and the Mental Component Score (MCS) scores (all p-values ≤ 0.042). 0.116 0.951 common threshold accepted in China (US$ 5,100 per QALY gained), combined treatment could be considered a costeffective option compared to treatment as usual. The combined treatment was always a dominant strategy over treatment as usual
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