Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study)

Background Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited. Aims To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment. Method An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken. Results The mean total costs of OPUS over 5 years (123683, s.e.=8970) were not significantly different from that of standard treatment ( 148751, s.e.=13073). At 2-year followup the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d.=15.15) was significantly higher than in standard treatment group (51.13, s.d.=15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d.=18.28) and 54.16 (s.d.=18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to 50 000 the probability that OPUS was cost-effective was more than 80%. Conclusions The incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.