1. Cognitive-behavioural therapy for persistent and recurrent psychosis in people with schizophrenia-spectrum disorder
- Author
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A. Dennis Stant, Mark van der Gaag, Erik Buskens, Durk Wiersma, Kerstin Wolters, Science in Healthy Ageing & healthcaRE (SHARE), Methods in Medicines evaluation & Outcomes research (M2O), Clinical Psychology, and EMGO+ - Mental Health
- Subjects
Adult ,Male ,medicine.medical_specialty ,Psychosis ,Time Factors ,Adolescent ,Cost-Benefit Analysis ,Population ,Affect (psychology) ,ECONOMIC-EVALUATION ,law.invention ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Randomized controlled trial ,law ,Recurrence ,Activities of Daily Living ,Outcome Assessment, Health Care ,medicine ,Humans ,030212 general & internal medicine ,education ,Psychiatry ,health care economics and organizations ,METAANALYSIS ,SCALE ,Psychiatric Status Rating Scales ,education.field_of_study ,Cognitive Behavioral Therapy ,Cognition ,Cost-effectiveness analysis ,Health Care Costs ,Middle Aged ,RANDOMIZED CONTROLLED-TRIAL ,medicine.disease ,030227 psychiatry ,Hospitalization ,Psychiatry and Mental health ,FAMILY INTERVENTION ,Psychotic Disorders ,Schizophrenia ,Economic evaluation ,Female ,Schizophrenic Psychology ,Psychology ,FOLLOW-UP ,HALLUCINATIONS - Abstract
BackgroundEvidence on cost-effectiveness is important to make well-informed decisions regarding care delivery.AimsTo determine the balance between costs and health outcomes of cognitive–behavioural therapy (CBT) compared with treatment as usual (TAU) in people with schizophrenia who have persistent and recurrent symptoms of psychosis. Trial number: ISRCTN57292778.MethodA total of 216 people were randomised and followed up for 18 months. The primary clinical outcome measure was time functioning within the normal range. Normal functioning was defined as social functioning within the 95% range of the general population and no or minimal suffering and/or no or minimal affect on daily life of persistent psychotic symptoms. The difference in number of days was estimated. Using a societal perspective, cost differences were estimated and combined with clinical outcome to yield an incremental cost-effectiveness ratio (ICER). Uncertainty was accessed using bootstrapping and displayed by means of a cost-effectiveness acceptability curve.ResultsIn the CBT group, participants experienced 183 days of normal social functioning, whereas the TAU group experienced 106 days. The ICER was e47 per day of normal functioning gained. Cognitive–behavioural therapy implies higher costs, yet results in better health outcomes. Sensitivity analyses showed that targeting individuals who have not been hospitalised before receiving CBT results in an ICER of e14 per day normal functioning gained.ConclusionsDays of normal functioning improved in the CBT condition compared with TAU, but this gain in health was associated with additional societal costs.
- Published
- 2011