Risk Stratification for Treatment Decisions in People at Ultra-High Risk for Psychosis: A Cost-Effectiveness Analysis
Abstract
People with psychotic disorders have long-term negative health outcomes and contribute large health system costs. Intervening among those at ultra-high risk (UHR) for psychosis may prevent or mitigate risk for psychotic disorder; however, it is unclear if we should treat all UHR individuals or only those above a certain risk threshold. The objectives were to systematically review the literature on the cost-effectiveness of UHR programs, and to conduct an economic evaluation of a risk stratification strategy, where treatment decisions are based on the probability of transitioning to psychotic disorder. Our systematic review found that UHR programs are potentially cost-effective. The economic evaluation found that only treating those at ≥20% risk to transition is cost saving to the Canadian health system, but returns worse health outcomes ($15,466 per quality-adjusted life-year), relative to treating all UHR individuals. Future research requires better valuation of cost and outcomes and trials examining risk stratification.