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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 21, Issue 3, 2018. Pages: 123-130
Published Online: 1 September 2018

Copyright © 2018 ICMPE.


An Economic Evaluation of Coordinated Specialty Care (CSC) Services for First-Episode Psychosis in the U.S. Public Sector

Sean M. Murphy,1 Suat Kucukgoncu,2 Yuhua Bao,1 Fangyong Li,3 Cenk Tek,2 Nicholas J.K. Breitborde,4 Sinan Guloksuz,5 Vivek H. Phutane,6 Banu Ozkan,7 Jessica M. Pollard,8 John D. Cahill,9 Scott W. Woods,2 Robert A. Cole,10 Michael Schoenbaum,11 Vinod H. Srihari2

1Ph.D., Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
2M.D., Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
3MPH, MS, Yale Center for Analytical Science, Yale School of Public Health, New Haven, CT, USA
4PhD, Departments of Psychiatry and Behavioral Health & Psychology, The Ohio State University, Columbus, OH, USA
5M.D., Ph.D., Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, the Netherlands
6M.D., Goulburn Valley Health, Shepparton and Melbourne Medical School, University of Melbourne, Victoria, Australia
7M.D., Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ, USA
8Ph.D., Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
9MBBS, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
10MHSA, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
11Ph.D., Division of Services and Intervention Research, National Institute of Mental Health, Rockville, MD, USA

* Correspondence to: Sean M. Murphy, Ph.D., Department of Healthcare Policy & Research, 425 East 61st Street, Suite 301, New York, NY 10065, USA.
Tel.: +1-646-962 9710
E-mail: smm2010@med.cornell.edu

Source of Funding: This work was supported by grants to Dr. Srihari, principal investigator, from the Patrick and Catherine Weldon Donaghue Medical Research Foundation (DF07-014) and the National Institutes of Health (MH088971). The trial is registered at ClinicalTrials.gov (NCT00309452). The views expressed here are those of the authors, and not necessarily those of the National Institute of Mental Health, the National Institutes of Health, or the federal government. This work was funded in part by the State of Connecticut, Department of Mental Health and Addiction Services, but this publication does not express the views of the Department of Mental Health and Addiction Services or the State of Connecticut. The views and opinions expressed are those of the authors.


Background: Schizophrenia spectrum disorders exert a large and disproportionate economic impact. Early intervention services may be able to alleviate the burden of schizophrenia spectrum disorders on diagnosed individuals, caregivers, and society at large. Economic analyses of observational studies have supported investments in specialized team-based care for early psychosis; however, questions remain regarding the economic viability of first-episode services in the fragmented U.S. healthcare system. The clinic for Specialized Treatment Early in Psychosis (STEP) was established in 2006, to explicitly model a nationally-relevant U.S. public-sector early intervention service. The purpose of this study was to conduct an economic evaluation of STEP, a Coordinated Specialty Care service (CSC) based in a U.S. State-funded community mental health center, relative to usual treatment (UT).

Methods: Eligible patients were within 5 years of psychosis onset and had no more than 12 weeks of lifetime antipsychotic exposure. Participants were randomized to STEP or UT. The annual per-patient cost of the STEP intervention per se was estimated assuming a steady-state caseload of 30 patients. A cost-offset analysis was conducted to estimate the net value of STEP from a third-party payer perspective. Participant healthcare service utilization was evaluated at 6 months and over the entire 12 months post randomization. Generalized linear model multivariable regressions were used to estimate the effect of STEP on healthcare costs over time, and generate predicted mean costs, which were combined with the per-patient cost of STEP.

Results: The annual per-patient cost of STEP was $1,984. STEP participants were significantly less likely to have any inpatient or ED visits; among individuals who did use such services in a given period, the associated costs were significantly lower for STEP participants at month 12. We did not observe a similar effect with regard to other healthcare services. The predicted average total costs were lower for STEP than UT, indicating a net benefit for STEP of $1,029 at month 6 and $2,991 at month 12; however, the differences were not statistically significant.

Conclusions: Our findings are promising with regard to the value of STEP to third-party payers.

Received 12 March 2018; accepted 4 August 2018

Copyright 2018 ICMPE