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Counting the indirect costs of psychosis

Early intervention (EI) services for people with psychosis are designed to improve outcomes, decrease illness severity and reduce a patient's risk of social drift, thereby limiting healthcare costs. A retrospective study of healthcare costs in Spain found that indirect costs related to factors such as work absence, job loss, care provided by social workers, and criminal justice services, account for the majority of healthcare expenditure during EI. Coordinated specialized care (CSC) programs, such as OnTrackNY, provide supported education and employment (SEE) services that help increase education/employment among people with early psychosis, potentially reducing indirect costs.

Indirect costs account for the majority of healthcare expenditure in FEP patients

A retrospective analysis of clinical records from 157 patients in the Programa Atención Fases Iniciales de Psychosis (PAFIP) and the Cantabria Health Service evaluated the short-term (1-year) direct and indirect cost of an EI FEP Program in Cantabria, Spain.1

Total costs during the first year of FEP care were more than €48,353 per patient; of these, direct healthcare costs accounted for 28.39% (€13,729), direct non-medical costs accounted for 0.22% (€109), and indirect costs accounted for 71.39% (€34,515). Hospitalization costs and treatment costs were higher in people with greater numbers of relapses. Higher indirect costs were observed in younger patients (i.e. those of working age). This suggests that greater healthcare resources should be allocated to young adults.

Hospitalization costs and treatment costs were higher in people with greater numbers of relapses

Supported education and employment (SEE) services increase rates of education and employment among people with FEP

The onset of psychosis is most common in young adulthood and although most people with psychosis want to work, the onset of symptoms at this critical time of life often disrupts academic/vocational trajectory. OnTrackNY is a novel coordinated specialized care, early intervention program available at 21 sites in New York. It provides team-based services, including psychotherapy, medication, family support/education, case management, and peer support, combined with SEE services, designed to increase education and employment.

A study of 779 patients enrolled in OnTrackNY investigated the effects of SEE on levels education/employment in people with FEP. Data were collected by clinical staff at admission and every quarter thereafter.

Overall 41% of participants were enrolled in work/school at baseline; OnTrackNY increased these rates to 63% after 3 months, and more than 70% after 6 months

Overall 41% of participants were enrolled in work/school at baseline; OnTrackNY increased these rates to 63% after 3 months, and more than 70% after 6 months. Use of SEE was highly correlated with levels of school enrolment in the subsequent quarter. However, the story was slightly different for employment. Although there was a significant association between SEE use and employment in the first few months, the positive association decreased towards the end of the first year. This suggests a benefit for ongoing SEE in schools but a reduced need for ongoing support in the workplace. Further studies are required to fully understand this relationship and to investigate the impact of increased education/employment on the indirect costs of early psychosis.  

References
  1. Mayoral-van Son J, et al. Early Interv Psychiatry. 2018. doi: 10.1111/eip.12752
  2. OnTrackNY http://www.ontrackny.org/
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