OBJECTIVES: Waiting lists were a common issue in many areas of healthcare pre-pandemic. COVID-19 has exacerbated the situation, particularly within mental health. Waiting times are likely to have a significant impact on factors including treatment outcomes, waiting costs and health related quality of life. The objective of this paper was to investigate the potential impact that waiting times may have on cost-effectiveness results, through developing an early economic model on cognitive behavioural therapy (CBT) treatment for anxiety.

METHODS: A decision analytic model in the form of a decision tree was used to model three comparator waiting times: the clinical commissioning groups (CCGs) with the shortest, average and longest waiting times for CBT treatment for anxiety in 2020/21. Parameter inputs were obtained from published literature, using UK specific sources where possible. Deterministic sensitivity analyses (DSA) were conducted to assess the robustness of result. Various scenarios were also conducted, to further investigate the model results.

RESULTS: The base case results suggested that shorter waiting times were associated with higher quality-adjusted life year gains and higher costs, compared to longer waiting times. This resulted in an incremental cost-effectiveness ratio of £14,064 between the shortest and longest waiting times. The higher costs of the shortest wait times was shown to be driven by the high dropout rates for longer waiting times. DSA indicated the results of the model to be dependent on the utility values by anxiety severity and the cost of CBT sessions. Further threshold analysis indicated the amount of money to be invested towards reducing waiting times whilst remaining cost-effective. This was estimated to be £152.88 per person in the longest wait-time CCG.

CONCLUSIONS: Based on this analysis, waiting times potentially lead to a negative impact on cost-effectiveness results. Furthermore, it was shown that investing to reduce waiting times could be a cost-effective use of resources.