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Economic impact of early intervention in psychosis services: results from a longitudinal retrospective controlled study in England
  1. Apostolos Tsiachristas1,
  2. Tony Thomas2,
  3. Jose Leal1,
  4. Belinda R Lennox3
  1. 1Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2Janssen Healthcare Innovation, Johnson & Johnson, High Wycombe, UK
  3. 3Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
  1. Correspondence to Dr Belinda R Lennox; Belinda.lennox{at}


Objectives To demonstrate the costs, outcomes and economic impact of early intervention in psychosis (EIP) services.

Design Longitudinal retrospective observational study of service usage and outcome data from mental health and acute care services for all those with a diagnosis of psychosis in contact with mental health services over a 3-year period (April 2010–March 2013).

Setting Thames Valley and South Midlands region in England (region covered by Oxford Academic Health Science Network).

Participants 3674 people with psychosis, aged 16–35 years.

Interventions EIP team or other community mental health teams.

Main outcome measures Change in housing status, change in employment status and improvement on each of the four domains of the Health of the Nation Outcome Scale (HONOS) questionnaire. Costs of mental and acute health inpatient, outpatient and community service use were also included in the study.

Results Patients in EIP services were 116% more likely (95% CI 1.263 to 3.708) to gain employment, 52% more likely to become accommodated in a mainstream house (95% CI 0.988 to 2.326) and 17% more likely to have an improvement in the emotional well-being domain of the HONOS questionnaire (95% CI 1.067 to 1.285), as compared to those in non-EIP services. Annual National Health Service (NHS) costs were also significantly lower for patients using EIP services compared to non-users. The mean annual NHS cost savings associated with EIP were £4031 (95% CI £1281 to £6780). These mostly came from lower mental health inpatient costs (£4075, 95% CI £1164 to £6986), lower acute hospital outpatient costs (£59, 95% CI £9 to £109), lower accident and emergency costs (£31, 95% CI £12 to £51), and higher mental health community costs (£648, 95% CI £122 to £1175). If all people with a first-episode psychosis across England were to be treated by EIP services, the savings in societal costs would be an estimated £63.3 million per year, of which £33.5 million would be in NHS costs.

Conclusions Treatment within an EIP service is associated with better health and social outcomes, and reduced costs.

  • early intervention
  • costs
  • outcomes
  • United Kingdom

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  • Data Raw data used for the analysis were licenced from the HSCIC by Janssen Healthcare Innovation. Initial extraction, preliminary analysis and summary data generation was performed by TT, under the supervision of BL and AT. AT performed further statistical analyses using summary data. At no point were raw data accessed by anyone other than the licensee (TT). All authors take responsibility for the integrity of the data extraction and the accuracy of the data analysis.

  • Contributors BRL, AT, JL and TT designed the study. TT, JL and AT undertook data analysis, and BRL, AT, JL and TT drafted and edited the paper. BRL acts as guarantor for the study.

  • Funding This research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust and Oxford AHSN. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Johnson & Johnson. The funder had no role in the collection, analysis or interpretation of data, in the writing of the report or in the decision to submit the article for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.