Objectives: Information technology aided relapse prevention programme in schizophrenia (ITAREPS) is a unique mobile phone-based telemedicine solution for weekly remote patient monitoring and disease management of psychotic disorders in general, particularly of schizophrenia. RCTs evidence suggests that ITAREPS is highly effective in decreasing hospitalization schizophrenia relapses. Based on these RCTs, we performed a cost-utility analysis of ITAREPS compared to the treatment of schizophrenia without ITAREPS in the Czech Republic. Methods: We developed a 20-year Markov cohort model with yearly cycle length and four health states, i.e. without relapse, with non-hospitalization relapse, with hospitalization relapse and death. Transition probabilities and resource use were derived from the Czech RCT and utilities were derived from published literature. Costs were calculated from healthcare payer's perspective. Costs and outcomes were discounted by 3%. Probabilistic sensitivity analysis (PSA) with 3000 iterations was performed. Results: Over a 20-year time horizon, ITAREPS compared to non- ITAREPS brings additional 0.21 QALY (12.33 vs. 12.12). The incremental total costs were - 5,554 ( 55,435 vs. 60,989) for ITAREPS. The insignificantly higher costs of ITAREPS service itself ( 155 in the first and 120 in subsequent years) are therefore vastly offset by savings of hospitalization relapse costs ( 1,243 vs. 11,748); ITAREPS on average prevents 5 hospitalization relapses in 20-year time horizon (0.73 vs. 5.77 hospitalizations) per patient. The results of the PSA show that ITAREPS is cost-effective in 93% iterations under the WTP threshold equal to 0. An extensive scenario analysis confirmed the base-case results, ITAREPS was dominant in all scenarios. Conclusions: ITAREPS is a highly cost-effective intervention in patients with schizophrenia and it is even a dominant intervention in comparison with non-ITAREPS since it is more effective in terms of QALY gained and cheaper at the same time. There is even 93% probability of ITAREPS being cost-effective at the WTP threshold equal to 0.
Mlcoch, T., Kruntoradova, K., Mandelikova, M., & Dolezal, T. (2015). Cost-Effectiveness Analysis of the Information Technology Aided Relaps Prevention Programme in Schizophrenia (Itareps) in the Czech Republic. Value in Health, 18(7), A410. https://doi.org/10.1016/j.jval.2015.09.976