The Cost-Effectiveness of a Novel Online Social Therapy to Maintain Treatment Effects From First-Episode Psychosis Services: Results From the Horyzons Randomized Controlled Trial

Lidia Engel; Mario Alvarez-Jimenez; Daniela Cagliarini; Simon D'Alfonso; Jan Faller; Lee Valentine; Peter Koval; Sarah Bendall; Shaunagh O'Sullivan; Simon Rice; Chris Miles; David L Penn; Jess Phillips; Penni Russon; Reeva Lederman; Eoin Killackey; Shalini Lal; Sue Maree Cotton; Cesar Gonzalez-Blanch; Helen Herrman; Patrick D McGorry; John F M Gleeson; Cathrine Mihalopoulos

doi:10.1093/schbul/sbad071

The Cost-Effectiveness of a Novel Online Social Therapy to Maintain Treatment Effects From First-Episode Psychosis Services: Results From the Horyzons Randomized Controlled Trial

Schizophr Bull. 2024 Mar 7;50(2):427-436. doi: 10.1093/schbul/sbad071.

Authors

Lidia Engel¹, Mario Alvarez-Jimenez^{2

3}, Daniela Cagliarini^{2

3}, Simon D'Alfonso⁴, Jan Faller¹, Lee Valentine^{2

3}, Peter Koval⁵, Sarah Bendall^{2

3}, Shaunagh O'Sullivan^{2

3}, Simon Rice^{2

3}, Chris Miles^{2

3}, David L Penn^{6

7}, Jess Phillips^{2

3}, Penni Russon⁸, Reeva Lederman⁴, Eoin Killackey^{2

3}, Shalini Lal^{9

10

11}, Sue Maree Cotton^{2

3}, Cesar Gonzalez-Blanch^{3

12}, Helen Herrman^{2

3}, Patrick D McGorry^{2

3}, John F M Gleeson⁷, Cathrine Mihalopoulos^{1

13}

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
² Orygen, Parkville, VIC, Australia.
³ Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
⁴ School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia.
⁵ Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia.
⁶ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
⁷ Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.
⁸ School of Communication, University of Technology Sydney, Sydney, NWS, Australia.
⁹ School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
¹⁰ Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada.
¹¹ Douglas Mental Health University Institute, Montreal, QC, Canada.
¹² University Hospital Marques de Valdecilla-IDIVAL, Santander, Spain.
¹³ Deakin Health Economics, Deakin University, Burwood, VIC, Australia.

Abstract

Background: Digital interventions have potential applications in promoting long-term recovery and improving outcomes in first-episode psychosis (FEP). This study aimed to evaluate the cost-effectiveness of Horyzons, a novel online social therapy to support young people aged 16-27 years following discharge from FEP services, compared with treatment as usual (TAU) from a healthcare sector and a societal perspective.

Study design: A cost-effectiveness analysis (CEA), based on the change in social functioning, and a cost-utility analysis (CUA) using quality-adjusted life years were undertaken alongside a randomized controlled trial. Intervention costs were determined from study records; resources used by patients were collected from a resource-use questionnaire and administrative data. Mean costs and outcomes were compared at 18 months and incremental cost-effectiveness ratios were calculated. Uncertainty analysis using bootstrapping and sensitivity analyses was conducted.

Study results: The sample included 170 participants: Horyzons intervention group (n = 86) and TAU (n = 84). Total costs were significantly lower in the Horyzons group compared with TAU from both the healthcare sector (-AU$4789.59; P < .001) and the societal perspective (-AU$5131.14; P < .001). In the CEA, Horyzons was dominant, meaning it was less costly and resulted in better social functioning. In the CUA, the Horyzons intervention resulted in fewer costs but also yielded fewer QALYs. However, group differences in outcomes were not statistically significant. When young people engaged more with the platform, costs were shown to decrease and outcomes improved.

Conclusions: The Horyzons intervention offers a cost-effective approach for improving social functioning in young people with FEP after discharge from early intervention services.

Keywords: economic evaluation; online intervention; psychosis; quality of life; social functioning; youth.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Cost-Benefit Analysis
Cost-Effectiveness Analysis*
Humans
Psychotic Disorders* / therapy

Abstract

Publication types

MeSH terms

Grants and funding