Early, aggressive psychosis treatment justifies cost

The additional cost of intensive treatment for individuals who have just experienced their first psychotic episode is justified by the significant improvement the treatment produces in quality of life, according to a Yale-led study published Feb. 1 in the journal Schizophrenia Bulletin.

"Typically, only the sickest people receive the most intensive treatments, but our analysis shows that aggressive early intervention pays off with improved relationships, a greater likelihood of being enrolled in school or employed, and an overall sense of well-being," said Dr. Robert Rosenheck, professor of psychiatry and public health at Yale, senior associate in Health Services Research at the VA New England Mental Illness, Research, Education and Clinical Center, and lead author of the study.

The first onset of schizophrenia—marked by delusions, hallucinations, disorganized thinking, and inability to maintain daily routine—usually occurs in young adults, who often are unaware of what is happening to them. Anti-psychotic drugs yield only partial improvement for most people with the disorder, which can cause profound long-term disability.

The National Institute of Mental Health (NIHM) in 2014 earmarked $25 million to investigate whether comprehensive early treatment can improve outcomes and especially the most important outcome—quality of life. Several studies have found that providing services such as personalized medication counseling, family counseling, self-management therapy, and job and education counseling can reduce symptoms for newly diagnosed people with schizophrenia as compared to standard community care, but the studies have not focused on quality of life and cost-effectiveness. The new study led by Rosenheck and John Kane of the Hofstra North Shore-LIJ School of Medicine, senior author of the paper, used a complex analysis to show the quality of life benefits justified the approximately 27% increase in costs from the standard care approach.

"The question people hesitate to ask is: How much should we spend to help someone to live a better life—actively socializing, engaged in the world, and curious about things going on around them?" Rosenheck said, "The answer is that the quality of life benefits realized by providing the right treatment at the right time are greater than the costs."