Psychiatry ·
Early antipsychotic reduction unlikely to be cost-effective after first-episode psychosis
A trial-based economic analysis of 347 remitted first-episode psychosis participants compared guided antipsychotic dose reduction or discontinuation with maintenance treatment. Over 24 months, early reduction was associated with lower quality-adjusted life years and higher or comparable costs, with an estimated 9% probability of being cost-effective at the stated threshold.
- Analysis included 347 remitted first-episode psychosis participants.
- Early reduction yielded 0.077 fewer QALYs over 24 months.
- Cost-effectiveness probability was about 9% at €50,000/QALY.
- Longer-term functional and economic effects remain uncertain.
The trial-based cost-utility analysis was conducted alongside the HAMLETT study. It included 347 participants in remission after a first episode of psychosis, randomized to guided antipsychotic dose reduction or discontinuation, or maintenance treatment, for one year. Costs and health outcomes were assessed over 24 months from healthcare and societal perspectives; outcomes were measured in quality-adjusted life years (QALYs) using EQ-5D-5L data.
In the base-case societal analysis, early reduction or discontinuation had incremental costs of €23,563 and yielded 0.077 fewer QALYs than maintenance. At a willingness-to-pay threshold of €50,000 per QALY, the incremental net monetary benefit was −€27,430. Across analyses, the estimated probability that early reduction or discontinuation was cost-effective was approximately 9%. A subgroup analysis suggested a small, uncertain positive net monetary benefit among participants recorded female at birth.
The findings suggest that early reduction or discontinuation was unlikely to be cost-effective over two years in this study. They do not resolve whether longer-term functional benefits may alter the economic balance. The abstract reports a trial-based analysis, but full-text methods and results were not available in the supplied material; the subgroup finding is uncertain and should be interpreted cautiously.
In practice
For people in remission after a first episode of psychosis, this HAMLETT-based analysis found early guided antipsychotic dose reduction or discontinuation was unlikely to be cost-effective compared with maintenance over 24 months. The analysis reported fewer QALYs and higher or comparable costs with early reduction; it does not establish that an individual patient should continue treatment, nor does it compare clinical outcomes in detail here. Possible longer-term functional benefits and the uncertain subgroup result mean these findings do not settle the longer-term balance.
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Acta Psychiatrica Scandinavica: Cost‐Effectiveness of Early Dose Reduction or Discontinuation Versus Antipsychotic Maintenance After First‐Episode Psychosis: Results From the HAMLETT Study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.