Cost and health impacts of adherence to the National Institute for Health and Care Excellence schizophrenia guideline recommendations

Background Discrepancies between the National Institute for Health and Care Excellence (NICE) schizophrenia guideline recommendations and current clinical practice in the UK have been reported.
Aims We aim to assess whether it is cost-effective to improve adherence to the NICE schizophrenia guideline recommendations, compared with current practice.
Method A previously developed whole disease model for schizophrenia using discrete event simulation method was adapted to assess the cost and health impacts of adherence to the NICE recommendations. Three scenarios to improve adherence to the clinical guidelines were modelled: (1) universal provision of cognitive behaviour therapy (CBT) for patients at clinical high risk of psychosis; (2) universal provision of family intervention for patients with a first-episode psychosis (FEP); (3) prompt provision of clozapine for patients with treatment resistant schizophrenia (TRS). The primary outcomes were lifetime costs and quality-adjusted life years (QALYs) gained.
Results The results suggest full adherence to the guideline recommendations would decrease cost and improve QALYs. Based on NICE’s £20,000-£30,000 per QALY gained willingness-to-pay threshold, prompt provision of clozapine for patients with TRS results in the greatest net monetary benefit, followed by universal provision of CBT for patients at CHR, and universal provision of family intervention for patients with a FEP.
Conclusions Our results suggest that adherence to guideline recommendations would decrease cost and improve QALYs. Greater investment is needed to improve guideline adherence in order to improve patient quality of life and realise potential cost-savings.