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Multifamily Psychoeducation for First-Episode Psychosis: A Cost-Effectiveness Analysis

Dr. Breitborde is affiliated with the Department of Psychiatry, University of Arizona, 1501 N. Campbell Ave., P.O. Box 245002, Tucson, AZ 85724-5002 (e-mail: breitbor{at}email.arizona.edu). Dr. Woods and Dr. Srihari are affiliated with the Department of Psychiatry, Yale University, New Haven, Connecticut. The results of this study were presented at the annual meeting of the American Psychological Association, Boston, August 14–17, 2008.

OBJECTIVE: Family psychoeducation is considered part of optimal treatment for first-episode psychosis, but concerns about the cost of this intervention have limited its availability. Although evidence suggests that family psychoeducation is cost-effective, many cost-effectiveness analyses have suffered from limitations that reduce their utility in guiding decisions to incorporate this intervention within existing clinical services. These include not presenting results in present-day dollars and not examining whether the intervention would remain cost-effective in situations where the clinical benefits achieved were smaller than those reported in past studies. Thus the goal of this study was to investigate the cost of providing a specific psychoeducation program—multifamily group psychoeducation—to individuals with first-episode psychosis and their families. METHODS: Statistical simulation was used to estimate the cost and burden of illness associated with usual treatment versus usual treatment plus multifamily group psychoeducation. In addition, the simulation model was rerun to test whether multifamily psychoeducation would remain cost-effective in situations where the clinical benefits achieved were smaller than those reported in past studies. RESULTS: When provided for two years, multifamily group psychoeducation ranged from a cost-effective to a cost-saving intervention, depending on the clinical benefits achieved by staff delivering the intervention. When provided for longer durations (five, ten, or 20 years), multifamily psychoeducation was a cost-saving intervention even in scenarios where the clinical benefits of the intervention were reduced by 90%. CONCLUSIONS: The results suggest that multifamily group psychoeducation may not only be a cost-effective intervention for first-episode psychosis but may often be a cost-saving intervention.

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