Cost-effectiveness of adherence therapy versus health education for people with schizophrenia: randomised controlled trial in four European countries

Cost Effectiveness and Resource Allocation

Martin Knapp⁴  Aart Schene⁷  Martijn Kikkert⁵  Matthias Angermeyer⁹  Reinhold Kilian⁸  Michele Tansella¹  Francesco Amaddeo⁶  Morven Leese²  Paul McCrone³  Anita Patel³ 

[1] WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, Verona, 37134, Italy;Health Service & Population Research Department, PO 29, Institute of Psychiatry, King’s College London, De Crespigny Park, London, SE5 8AF, United Kingdom;Centre for the Economics of Mental & Physical Health, PO 24, Institute of Psychiatry, King’s College London, De Crespigny Park, London, SE5 8AF, United Kingdom;Personal Social Services Research Unit, London School of Economics & Political Science, Houghton Street, London, WC2A 2AE, United Kingdom;Arkin, Overschiestraat 65, Amsterdam, 1062 XD, The Netherlands;Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, Verona, 37134, Italy;Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Room PA1-156 1105 AZ, Amsterdam, The Netherlands;Department of Psychiatry and Psychotherapy, Ulm University, am Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Str. 2, Günzburg, D-89312, Germany;Center for Public Mental Health, Untere Zeile 13, Gösing am Wagram, A-3482, Austria

关键词: Psychological therapy;    Schizophrenia;    Adherence;    Antipsychotic;    Quality-adjusted life year;    Cost effectiveness;   

Others  :  810662
DOI  :  10.1186/1478-7547-11-12

 received in 2012-07-31, accepted in 2013-05-15,  发布年份 2013

【 摘 要 】

Background

Non-adherence to anti-psychotics is common, expensive and affects recovery. We therefore examine the cost-effectiveness of adherence therapy for people with schizophrenia by multi-centre randomised trial in Amsterdam, London, Leipzig and Verona.

Methods

Participants received 8 sessions of adherence therapy or health education. We measured lost productivity and use of health/social care, criminal justice system and informal care at baseline and one year to estimate and compare mean total costs from health/social care and societal perspectives. Outcomes were the Short Form 36 (SF-36) mental component score (MCS) and quality-adjusted life years (QALYs) gained (SF-36 and EuroQoL 5 dimension (EQ5D)). Cost-effectiveness was examined for all cost and outcome combinations using cost-effectiveness acceptability curves (CEACs).

Results

409 participants were recruited. There were no cost or outcome differences between adherence therapy and health education. The probability of adherence therapy being cost-effective compared to health education was between 0.3 and 0.6 for the six cost-outcome combinations at the willingness to pay thresholds we examined.

Conclusions

Adherence therapy appears equivalent to health education. It is unclear whether it would have performed differently against a treatment as usual control, whether such an intervention can impact on quality of life in the short-term, or whether it is likely to be cost-effective in some sites but not others.

Trial registration

Trial registration: Current Controlled TrialsISRCTN01816159

【 授权许可】

   
2013 Patel et al.; licensee BioMed Central Ltd.

【 图 表 】

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