Cost Effectiveness of Cognitive Behavioural Therapy for Psychosis Through Reduced Hospitalisation

OBJECTIVES: The National Institute for Health and Care Excellence (NICE) and various (inter)national guidelines recommend that Cognitive Behavioural Therapy for psychosis (CBTp) should be offered to patients with a psychotic disorder (SSD). Nevertheless, many SSD patients currently have no access to this therapy. Little is known about the long-term cost-effectiveness of CBTp. This study highlights the importance of CBTp implementation in clinical practice. The main objective of the current study was to evaluate the cost effectiveness of CBTp for treating psychotic disorders using a patient-level simulation model.

METHODS: Administrative data on SSD patients (N = 10,229) in the Netherlands were collected between 2000 and 2019. The long-term effect of CBTp on healthcare use was modelled using a micro-simulation model and intention to treat analysis, where the effect on rehospitalisation rates was based on evidence from literature. Treatment as usual (TAU) was compared with TAU+CBTp. Various sensitivity analyses, such as differing treatment effect duration (base case = 2 years), were conducted. The modelled outcomes were: quality adjusted life years (QALYs) gained, and total costs of mental healthcare, both discounted at 3.5%.

RESULTS: TAU+CBTp was estimated to be the dominant treatment in more than 80% of the simulations of the base analysis. The discounted QALY gains were 0.034 and discounted cost savings were €4500 per patient on average. A total QALY gain of 348 years and a total cost savings of 46 million euros could be obtained through an initial investment of 18 million euros for the study population.

CONCLUSIONS: The evaluation shows that CBTp is generally a cost effective treatment. These findings stress the importance of sufficient availability of CBTp for SSD patients. Making CBTp available for all SSD patients, as guidelines recommend, could lead to substantial health gains for the SSD population and cost savings from the healthcare perspective in the Netherlands.