By Benedict Carey
February 1, 2016
A new approach to treating early schizophrenia, which includes family counseling, results in improvements in quality of life that make it worth the added expense, researchers reported on Monday.
The study, published by the journal Schizophrenia Bulletin, is the first rigorous cost analysis of a federally backed treatment program that more than a dozen states have begun trying. In contrast to traditional outpatient care, which generally provides only services covered by insurance, like drugs and some psychotherapy, the new program offers other forms of support, such as help with jobs and school, as well as family counseling.
The program also tries to include the patients — people struggling with a first psychotic “break” from reality, most of them in their late teens and 20s — as equals in decisions about care, including drug dosage.
In a widely anticipated study last fall, called the Raise trial, researchers reported that after two years, people who got this more comprehensive care did better on a variety of measures than those who received the standard care. But the study found no evidence of related cost savings or differences in hospitalization rates, a prime driver of expense. As lawmakers in Washington are considering broad changes in mental health care, cost issues loom especially large.
Outside experts said this analysis — which was based on the Raise trial data — was an important test of the new care program’s value.
“This is the way cost analysis should be done,” Sherry Glied, a professor of public service and the dean of New York University’s graduate school of public service, said. “One way to think about it is to ask, if this program were a drug, would we pay for it? And the answer is yes.”
Swaying policy makers will take far more work, others said.
“This study shows that the treatment is promising, in a research setting,” said Thomas McGuire, a professor of health economics at Harvard Medical School. “We’ll still need to see how it works in the real world, whether it makes sense for community mental health clinics.”
The new research, led by Dr. Robert Rosenheck of the Yale School of Medicine, included 183 people who received typical care and 223 who got the more comprehensive services. The study aimed in part to assess whether investing more money in early treatment might forestall much higher costs later on.
The new analysis could not settle that question, because it compiled data from only two years. (Lifetime studies could estimate differences such as whether people stay in the workplace or off government assistance.) The researchers evaluated the costs of all added services, including the price for training and mounting the new program, and asked what differences in average quality of life that money yielded.
The treatment package cost about $3,600 a year more than traditional outpatient care, the researchers found, and resulted in an improvement of about 13 percent over the usual care. That measure included how patients were doing at home, in their primary relationships and in school or at work.
“We then had to ask, ‘How do we put a precise value on improved quality of life?’ ” Dr. Rosenheck said.
Using standard scales applied to other health care, like medications and operations, the team found that the new approach delivered about the same value of health benefits as other widely accepted treatments, like statin drugs to prevent heart attacks, Dr. Rosenheck said, and was more cost effective than many cancer therapies.
The extra money spent, in short, “is at the low end of the range of services we already pay for,” Dr. Glied said.
This cost-benefit ratio may improve in the coming years. Many medications used for schizophrenia are close to becoming generic, which would lower the average added expense of the new program to about $2,000 a year. But given the uncertainties of a chronic condition like schizophrenia, experts said the new study should be considered a good first-term report card, not a final rating.
“One thing that’s incontrovertible is that when a child develops schizophrenia, your life’s a mess. A truck has just run you over,” Dr. Rosenheck said. “If nothing else, this intervention provides support for individuals and families at the worst times of their lives. It tells you that you will not be alone — there’s people looking to make this better.”