Economic evaluation of brief cognitive behavioural therapy for social activation in recent-onset psychosis.

Autor: Wijnen BFM; Centre for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.; CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands., Pos K; Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., Velthorst E; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States of America.; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, United States of America., Schirmbeck F; Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., Chan HY; CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands., de Haan L; Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., van der Gaag M; Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.; Parnassia Psychiatric Institute, The Hague, The Netherlands., Evers SMAA; Centre for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.; CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands., Smit F; Centre for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.; Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.; Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University medical center, Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2018 Nov 12; Vol. 13 (11), pp. e0206236. Date of Electronic Publication: 2018 Nov 12 (Print Publication: 2018).
DOI: 10.1371/journal.pone.0206236
Abstrakt: Background: In schizophrenia spectrum disorders, negative symptoms (e.g. social withdrawal) may persist after initial treatment with antipsychotics, much affecting the quality of life (QOL) of patients. This health-economic study evaluated if a dedicated form of cognitive behaviour therapy for social activation (CBTsa) would reduce negative symptoms and improve QOL in an economically sustainable way.
Methods: A health-economic evaluation was conducted alongside a single-blind randomised controlled trial in two parallel groups: guideline congruent treatment as usual (TAU; n = 50) versus TAU augmented with adjunct CBTsa (n = 49). Outcomes were PANSS negative symptom severity and EQ-5D quality adjusted life years (QALYs) gained. The health-economic evaluation was conducted both from the societal and the health sector perspective.
Results: Both conditions showed improvement in the respective outcomes over the follow-up period of six months, but QALY gains were significantly higher in the CBTsa condition compared to the TAU condition. Treatment response rate (i.e. ≥ 5-point decrease on the PANSS) was not significantly different. However, the add-on CBT intervention was associated with higher costs. This did not support the idea that CBTsa is a cost-effective adjunct. Various sensitivity analyses attested to the robustness of these findings.
Conclusions: In the Dutch context where TAU for psychosis is guideline congruent and well implemented there appears no added value for adjunct CBTsa. In other settings where the treatment for the schizophrenia spectrum disorders solely relies on antipsychotics, add-on CBTsa may lead to clinically superior outcomes, but it should still be evaluated if adjunct CBTsa therapy is a cost-effective alternative.
Trial Registration: ClinicalTrials.gov registry under NCT03217955.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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