Tuesday, June 28, 2016

Adding CBT to Usual Care in Early Intervention for Psychosis Found to Be Cost-Effective

Cognitive-behavior therapy as a preventive adjunct to usual care for patients at ultra-high risk (UHR) for psychosis appears to be more effective at preventing conversion to psychosis and more cost-effective compared with usual care alone in a program for UHR patients. The results appeared online in Schizophrenia Bulletin.

Researchers at the University of Amsterdam analyzed data from the Dutch Early Detection, Intervention, and Evaluation Trial, comparing cost-effectiveness of routine care (RC) only versus routine care with adjunctive CBT (CBTuhr). The primary outcome was treatment response, defined as the proportion of averted transitions to psychosis, and the secondary outcome was gain in quality-adjusted life years (QALYs), a measure of cost-effectiveness.

A total of 101 patients received RC only and 95 received CBTuhr. The researchers found that 24.8% of the RC patients transitioned to psychosis during the four-year follow-up period compared with 12.6% of the CBTuhr patients—a statistically significant difference.

Overall,the combined therapy cost less ($19,121) than routine care alone ($24,898).”The difference between CBTuhr and RC in intervention services received is partly explained by the lower psychosis conversion rate in the CBTuhr group and partly by a generally higher service use in RC,” the researchers state.

In addition, the cumulative gain in QALYs was higher for the CBTuhr group, though this difference was not statistically significant. (QALY in the study was measured using a version of the “EuroQoL” group, which consists of five health state dimensions—mobility, self-care, usual activities, pain/discomfort, and anxiety/depression—on which the respondent rates his/her own health. Each dimension has three levels: no problems, some problems, and extreme problems.)

"This study showed that CBTuhr had an 83% likelihood of resulting in a reduction of the transition to psychosis at a lower cost," the researchers stated. "There was a 75% likelihood that the intervention resulted in more QALY gains at lower costs."

(Image: kagenmi/istock.com)


The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.