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

• Published in: PloS one 2018-11, Vol.13 (11), p.e0206236-e0206236
• Main Authors: Wijnen, Ben F M, Pos, Karin, Velthorst, Eva, Schirmbeck, Frederike, Chan, Hoi Yau, de Haan, Lieuwe, van der Gaag, Mark, Evers, Silvia M A A, Smit, Filip
• Format: Article
• Language: English
• Subjects: Activation; Addictions; Adult; Antipsychotics; Behavior modification; Clinical psychology; Cognition & reasoning; Cognitive ability; Cognitive behavioral therapy; Cognitive Behavioral Therapy - economics; Cost analysis; Cost-Benefit Analysis - economics; Disorders; Economics; Emotional behavior; Encyclopedias; Evaluation; Female; Health care expenditures; Health services; Humans; Male; Medicine; Medicine and Health Sciences; Mental disorders; Mental health; Middle Aged; Primary care; Psychiatry; Psychosis; Psychotic Disorders - drug therapy; Psychotic Disorders - economics; Psychotic Disorders - epidemiology; Psychotropic drugs; Public health; Quality of Life; Quality-Adjusted Life Years; Questionnaires; Schizophrenia; Schizophrenia - drug therapy; Schizophrenia - economics; Schizophrenia - epidemiology; Sensitivity analysis; Single-Blind Method; Social Behavior; Social research; Social Sciences; Therapy; Withdrawal
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0206236

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. 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. 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. 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. ClinicalTrials.gov registry under NCT03217955.