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Coordinated schizophrenia treatment proves cost-effective, study says

Schizophrenia treatment emphasizing therapy costs more but produces better outcomes, researchers find

A new government-funded schizophrenia treatment program involving talk therapy and case management is more cost-effective in the long run than traditional treatments, which typically emphasize high doses of medication, according to a study published on Monday.

The treatment, which is backed by National Institute of Mental Health (NIMH), is called Navigate and involves what researchers are calling coordinated specialty care for people who have recently been diagnosed with schizophrenia, which affects an estimated 3 million people in the United States.

While the standard treatment for schizophrenia — a mental illness marked by hallucinations, paranoia and other forms of psychosis — emphasizes high doses of anti-psychotic medication, the Navigate program involves lower doses. Patients receive psychotherapy that emphasizes resilience, paired with case management to help them stay on top of school or work duties. Their family members get support and education about schizophrenia too.

An October 2015 study examining Navigate’s effectiveness compared with traditional schizophrenia treatment found that patients enrolled in the new program had significantly better outcomes in their interpersonal relationships and their participation in work or school. The earlier in their illnesses they were enrolled in coordinated specialty care, the better the patients fared, particularly if they started treatment soon after their first episodes of psychosis.

In the new study, which was published online in the journal Schizophrenia Bulletin, researchers from the Yale School of Medicine looked at the cost and treatment outcomes for 404 patients randomly assigned to Navigate or to a standard community care program from July 2010 to July 2012. 

The researchers found that while the Navigate treatment cost about $3,600 more per year than the standard care, patients experienced “significantly greater improvement” in their lives during the two years, or about 13 percent better than the control group.

“Health service costs are, not surprisingly, somewhat higher when the mental health system provides the full range of services these young people need at a very vulnerable time in their lives,” Robert Heinssen, the director of the division of services and intervention research at NIMH, said in a press release. “But these additional expenses have now been shown to be worth the investment in improving individuals’ health and functioning.”

The researchers also found that when patients were able to access generic anti-psychotic drugs, the costs of the Navigate program could be decreased by roughly $2,000 per year.

“The value of the achieved clinical benefit [of coordinated specialty care programs] appears to justify these additional expenditures, especially for clients with shorter [duration of untreated psychosis] and when generic prices for anti-psychotic medication are applied,” the authors wrote.

Countries such as Denmark and the United Kingdom that have nationalized health care systems have been able to create successful programs for schizophrenia that emphasize coordinated care.

In the U.S., 32 states have added early intervention programs to their existing programs to treat first-episode psychosis since 2014, using federal funds to subsidize services that insurance companies typically do not cover, such as care coordination and supported employment and education (PDF).

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