Health Economic Analysis of Psychology Adding Value Epilepsy Screening (PAVES) - a Screening and Intervention Programme for the Epilepsy Clinic

Objectives: Children and young people with epilepsy (CYPwE) are particularly vulnerable to comorbid mental health disorders. Psychology Adding Value: Epilepsy Screening (PAVES) is a screening and stepped psychology intervention tool found to be highly acceptable and feasible. It enables early intervention following epilepsy clinic avoiding delays in awaiting CAMHS treatment. Here we assess the cost-effectiveness of PAVES versus standard care. Methods: Data was collected from a PAVES pilot, routinely available data and standard cost sources. An economic model was created representing a cohort of 100 patients receiving PAVES or standard care. PAVES was compared with standard care which involved CAMHS referrals for patients with sufficient mental health difficulties. It was assumed that a ‘RED’ screen equated to a CAMHS referral in standard care. Results: The annual cost for 100 people receiving PAVES intervention is £24,700. Following a PAVES-eligible screen, it is assumed that PAVES is provided predominantly in the first year. Total cost of CAMHS referrals and treatment for the 3 year duration of the pilot phase was £53,515 in the PAVES group (22 referrals, 11 treated) and £110,849 in the standard care group (41 referrals, 20 treated). Given this, PAVES saves £32,634. Even if the cost of providing PAVES to all patients is incurred annually, the cost per CAMHS referral avoided is credible (i.e. £882). Conclusions: It is likely that early intervention through PAVES is both cheaper and avoids onward referrals to CAMHS. Hence, funding PAVES could be cost-effective for the NHS, with potential to benefit other health systems.
Keywords: epilepsy; children and young people; mental health; early intervention; cost-effectiveness