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

Ben F M Wijnen,Lieuwe De Haan,Karin Pos,Eva Velthorst,Silvia M A A Evers,Hoi Yau Chan,Filip Smit,Frederike Schirmbeck,Mark Van Der Gaag,Jacobus P Van Wouwe

doi:10.1371/journal.pone.0206236

Abstract

BackgroundIn 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.MethodsA 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.ResultsBoth 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.ConclusionsIn 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 registrationClinicalTrials.gov registry under NCT03217955.

Highlights

People with schizophrenia have been reported to have a diminished capacity for learning, working, self-care, interpersonal relationships and general living skills [1, 2]
Both conditions showed improvement in the respective outcomes over the follow-up period of six months, but quality adjusted life years (QALYs) gains were significantly higher in the cognitive behaviour therapy for social activation (CBTsa) condition compared to the treatment as usual (TAU) condition
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

Summary

Introduction

People with schizophrenia have been reported to have a diminished capacity for learning, working, self-care, interpersonal relationships and general living skills [1, 2]. Schizophrenia spectrum disorders entail significant cost to patients in terms of personal suffering, and on the caregiver as a result of the shift of burden of care from hospital to families in Europe [3] These disorders significantly increases the healthcare costs, e.g. by hospitalizations, need for long-term psychosocial support, and life-long productivity losses [3]. 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

Results

Discussion

Conclusion