Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program

Schizophr Bull. 2016 Jul;42(4):896-906. doi: 10.1093/schbul/sbv224. Epub 2016 Jan 31.


This study compares the cost-effectiveness of Navigate (NAV), a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis (FEP) and usual Community Care (CC) in a cluster randomization trial. Patients at 34 community treatment clinics were randomly assigned to either NAV (N = 223) or CC (N = 181) for 2 years. Effectiveness was measured as a one standard deviation change on the Quality of Life Scale (QLS-SD). Incremental cost effectiveness ratios were evaluated with bootstrap distributions. The Net Health Benefits Approach was used to evaluate the probability that the value of NAV benefits exceeded its costs relative to CC from the perspective of the health care system. The NAV group improved significantly more on the QLS and had higher outpatient mental health and antipsychotic medication costs. The incremental cost-effectiveness ratio was $12 081/QLS-SD, with a .94 probability that NAV was more cost-effective than CC at $40 000/QLS-SD. When converted to monetized Quality Adjusted Life Years, NAV benefits exceeded costs, especially at future generic drug prices.

Keywords: cost-effectiveness; quality adjusted life years; schizophrenia.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Community Mental Health Services / economics
  • Community Mental Health Services / standards*
  • Cost-Benefit Analysis*
  • Delivery of Health Care, Integrated / economics
  • Delivery of Health Care, Integrated / standards*
  • Female
  • Health Services Research
  • Humans
  • Male
  • National Institute of Mental Health (U.S.)
  • Outcome Assessment, Health Care*
  • Patient Care Team / economics
  • Patient Care Team / standards*
  • Psychotic Disorders / economics
  • Psychotic Disorders / therapy*
  • Schizophrenia / economics
  • Schizophrenia / therapy*
  • United States
  • Young Adult