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Economic consequences of alternative medication strategies in first episode non-affective psychosis

Published online by Cambridge University Press:  05 April 2007

A.D. Stant ,
E.M. TenVergert ,
L. Wunderink ,
F.J. Nienhuis  and
D. Wiersma
A.D. Stant*
Affiliation:
Office for Medical Technology Assessment, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
E.M. TenVergert
Affiliation:
Office for Medical Technology Assessment, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
L. Wunderink
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
F.J. Nienhuis
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
D. Wiersma
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
*
∗Corresponding author. Tel.: +31 50 361 2152; fax: +31 50 361 1738. E-mail addresses: a.d.stant@mta.umcg.nl (A.D. Stant), e.m.ten.vergert@ mta.umcg.nl (E.M. TenVergert), a.wunderink@acggn.umcg.nl (L. Wunderink), f.j.nienhuis@acggn.umcg.nl (F.J. Nienhuis), d.wiersma@acggn. umcg.nl (D. Wiersma).
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Abstract

Background

Maintenance treatment appears to be successful in preventing relapses in first episode psychosis, but is also associated with side effects. Guided discontinuation strategy is a less intrusive intervention, but may lead to more relapses. In the current economic evaluation, costs and health outcomes of discontinuation strategy will be compared with the results of maintenance treatment in patients with remitted first episode psychosis.

Method

The study was designed as a randomised clinical trial. In total 128 patients were prospectively followed for 18 months after six months of stable remission. The economic evaluation was conducted from a societal perspective. Quality-adjusted life years (QALYs) were used as primary health outcome in the economic evaluation. Relapse rates were assessed in addition to various other secondary outcomes.

Results

There were no relevant differences in mean costs between groups during the study. Total costs were largely influenced by costs related to admissions to psychiatric hospitals. No differences between groups were found for QALY results.

Conclusions

There were no indications that either of the examined interventions is superior to the other in terms of costs or QALY results. Additional results indicated that the relapse rate in discontinuation strategy was twice as high, but without an increase in hospital admissions or negative consequences on other clinical outcomes. For a minority of remitted first episode patients, guided discontinuation strategy may offer a feasible alternative to maintenance treatment.

Keywords

First episode psychosisAntipsychoticsMaintenance treatmentGuided discontinuationCostEconomic evaluation
Type
Original article
Information
European Psychiatry , Volume 22 , Issue 6 , September 2007 , pp. 347 - 353
Copyright
Copyright © Elsevier Masson SAS 2007

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