DIGITAL INTERVENTIONS OFFER A COST-SAVING APPROACH IN PROMOTING LONG-TERM RECOVERY IN FIRST EPISODE PSYCHOSIS PATIENTS

and educational attainment – core components of social recovery. Just recently, the intervention was also evaluated for its cost-effectiveness, showing that it provides good value for money and results in large net budget savings to the Australian healthcare system.

Cost-effectiveness evidence is crucial in guiding resource allocation decisions in health care, where resources are limited.

Psychotic disorders, which include conditions such as schizophrenia and bipolar disorder with psychotic features, impose a considerable burden on individuals affected by these disorders, as well as their families and society as a whole.

Psychosis involves a loss of contact with reality, leading to symptoms such as hallucinations, delusions, disorganized thinking, and impaired social functioning.

The early course of psychosis is characterized by recurrent relapses; up to 80% of first episode psychosis patients will experience a psychotic relapse within 5 years of remission from the initial episode. A relapse refers to the re-emergence of psychotic symptoms after a period of remission or improvement. It means that despite some initial recovery, individuals with psychosis are at a high risk of experiencing a relapse, which can significantly disrupt their lives.

Digital interventions have potential applications in promoting long-term recovery and improving outcomes in first episode psychosis patients. A novel online social therapy, called MOST, has recently been developed by a team of leading youth mental health experts and by young people with lived experience of mental ill-health at Orygen. MOST integrates peer-to-peer online social networking with theory-driven, evidence-informed therapeutic interventions targeting social functioning, vocational recovery and relapse prevention.

It is supported by peer workers, clinicians, and vocational professionals, with the aim of supporting young people with first episode psychosis following two years of specialised support.

As part of the Horyzons project, a randomised controlled trial of 170 young people aged 16-27 years following discharge from first episode psychosis services demonstrated that the digital intervention MOST was effective in improving vocational recovery or job prospects

By considering cost-effectiveness evidence, decisionmakers can prioritize interventions that provide good value by comparing the costs of implementing an intervention with the health benefits it produces, thereby prioritizing interventions with the greatest potential to improve health outcomes while considering the economic impact of those decisions.

The economic evaluation of the MOST intervention encompassed two evaluation frameworks: a costeffectiveness analysis, which evaluated outcomes by assessing changes in the social functioning of study participants, and a cost-utility analysis that specifically examined quality-adjusted life years (QALYs).

QALYs represent a way to measure and quantify both the length of life and the quality of life experienced by individuals and is a useful metric in health economics to compare cost-effectiveness evidence across disease areas and population groups.

Using data from the Horysons randomised controlled trial, the MOST intervention was compared to treatment as usual in terms of costs and benefits. Costs were measured from a healthcare sector perspective and a broader societal perspective, which also included productivity impacts and non-health services, such as vocational services.

The analysis revealed that over the 18-month study period, the cost of delivering the MOST intervention to study participants was estimated at $2,004 per participant. While this represents a significant cost, the analysis also showed that there were important cost-savings observed in the intervention arm compared with the control group, especially for emergency department presentations, hospital admissions and use of specialised mental health clinical services.

The differences in total costs between the intervention and the control group were estimated at $4,790 from a healthcare sector perspective and $5,131 from a societal perspective, showing that MOST was cost saving. Extrapolated to all eligible patients with psychosis aged 16-25 years in Australia, the expected net budget savings were estimated at $6.3 million under the healthcare perspective and $7.5 million under the societal perspective in year one ($788,164 and $939,312 in subsequent years, respectively).

The results also showed that the online intervention resulted in small improvements in social functioning but yielded fewer QALYs. However, there was a significant uncertainty observed in the outcome data that reflected the heterogeneity of user engagement with the online intervention.

When exploring the costs and outcomes by level of user engagement, it was shown that young people who engaged more with the platform reported better outcomes and lower costs. Therefore, the more young people used the platform, the more cost-effective it was.

Overall, the results indicate that Horyzons offers a cost-saving and likely a cost-effective approach for improving social functioning in young people with first episode psychosis after they are discharged from specialised services.

These findings have important implications for delivering first episode psychosis services in Australia and internationally, highlighting the value of online interventions for young people experiencing ill-mental health. Improving long-term recovery is a critical global research and clinical priority in psychosis treatment and across youth mental health. The MOST intervention provides a novel, promising, engaging, and cost-effective intervention to do so.

Authors: Dr Lidia Engel, Senior Research Fellow, Monash University Health Economics Group, Monash University. Prof Cathy Mihalopoulos, Head of the Monash University Health Economics Group, Monash University. Prof Mario AlvarezJimenez, Chief of Orygen Digital, Orygen.