Cost-effectiveness of adherence therapy versus health education for people with schizophrenia: randomised controlled tri
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RESEARCH
Open Access
Cost-effectiveness of adherence therapy versus health education for people with schizophrenia: randomised controlled trial in four European countries Anita Patel1*, Paul McCrone1, Morven Leese2, Francesco Amaddeo3, Michele Tansella3,4, Reinhold Kilian5, Matthias Angermeyer6, Martijn Kikkert7, Aart Schene8 and Martin Knapp1,9
Abstract 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: Current Controlled Trials ISRCTN: ISRCTN01816159. Keywords: Cost effectiveness, Quality-adjusted life year, Antipsychotic, Adherence, Schizophrenia, Psychological therapy
Background Schizophrenia has notable impacts upon patients, their families, services and the wider economy [1]. Due to its chronic nature, the main aim of health and social care interventions is to improve symptoms, long-term health and quality of life. Treatments and services come at a considerable cost and although it is entirely appropriate * Correspondence: anita.patel@kcl.ac.uk 1 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 Full list of author information is available at the end of the article
to invest resources in helping those affected to manage their illness, there are inevitable pressures to contain costs and use budgets as effectively as possible. Nonadherence (or non-compliance) with anti-psychotic medication is common, due to the severe side-effects that are associated with many of them, and is associated with higher inpatient and total treatment costs [2]. Improving medication adher
