Open Access Research

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 Tansella34, Reinhold Kilian5, Matthias Angermeyer6, Martijn Kikkert7, Aart Schene8 and Martin Knapp19

Author Affiliations

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

2 Health Service & Population Research Department, PO 29, Institute of Psychiatry, King’s College London, De Crespigny Park, London, SE5 8AF, United Kingdom

3 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

4 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

5 Department of Psychiatry and Psychotherapy, Ulm University, am Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Str. 2, Günzburg, D-89312, Germany

6 Center for Public Mental Health, Untere Zeile 13, Gösing am Wagram, A-3482, Austria

7 Arkin, Overschiestraat 65, Amsterdam, 1062 XD, The Netherlands

8 Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Room PA1-156 1105 AZ, Amsterdam, The Netherlands

9 Personal Social Services Research Unit, London School of Economics & Political Science, Houghton Street, London, WC2A 2AE, United Kingdom

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Cost Effectiveness and Resource Allocation 2013, 11:12  doi:10.1186/1478-7547-11-12

Published: 25 May 2013

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

Trial registration: Current Controlled Trials ISRCTN01816159

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