Cost-effectiveness of treating first-episode psychosis: five year follow-up results from an Italian early intervention programme

Aim: Early intervention programmes are expected to result in the reduction of illness severity in patients with schizophrenia, and contain healthcare costs by reducing hospital admissions and improving the social functioning of patients. This study aimed to investigate the costeffectiveness of treatment in an early intervention programme in comparison to standard care. Methods: Retrospective analysis of data prospectively recorded in an urban area (Milan, Italy). Twentythree patients from an early intervention programme and 23 patients from standard care with first-episode psychosis were evaluated on their use of services over a 5-year period. The Health of the Nation Outcome Scale was used to measure clinical status. Results: Significant changes with respect to initial assessment were recorded on the Health of the Nation Outcome Scale,with larger effect sizes in the early intervention programme than in the standard care group. Consequently, the cost-effectiveness ratio per reduced score of severity was lower in the early intervention programme than in standard care (€ 4802 vs. € 9871), with an incremental costeffectiveness ratio, or net saving of € -1204 for every incremental reduced score of severity. Over time, greater recourse to hospital and residential facilities to obtain comparable improvement in symptoms resulted in a steady cost increase for the patients in standard care. Conclusions: Allocation of funds to specialized early intervention programmes is the best alternative, as it can save costs by reducing the use of hospitals and residential facilities, and may produce net savings of costs in the long term.