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Cost-Effectiveness Evaluations of Psychological Therapies for Schizophrenia and Bipolar Disorder: A Systematic Review

Published online by Cambridge University Press:  22 July 2019

Gemma Elizabeth Shields Open the ORCID record for Gemma Elizabeth Shields [Opens in a new window] ,
Deborah Buck ,
Jamie Elvidge ,
Karen Petra Hayhurst  and
Linda Mary Davies
Gemma Elizabeth Shields*
Affiliation:
Centre for Health Economics, Division of Population Health, University of Manchester
Deborah Buck
Affiliation:
Personal and Social Services Research Unit, University of Manchester
Jamie Elvidge
Affiliation:
National Institute for Health and Care Excellence, United Kingdom
Karen Petra Hayhurst
Affiliation:
Division of Psychology and Mental Health, University of Manchester, Manchester
Linda Mary Davies
Affiliation:
Centre for Health Economics, Division of Population Health, University of Manchester
*
Author for correspondence: Gemma E. Shields, E-mail: gemma.shields@manchester.ac.uk
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Abstract

Objectives

This review aims to assess the cost-effectiveness of psychological interventions for schizophrenia/bipolar disorder (BD), to determine the robustness of current evidence and identify gaps in the available evidence.

Methods

Electronic searches (PsycINFO, MEDLINE, Embase) identified economic evaluations relating incremental cost to outcomes in the form of an incremental cost-effectiveness ratio published in English since 2000. Searches were concluded in November 2018. Inclusion criteria were: adults with schizophrenia/BD; any psychological/psychosocial intervention (e.g., psychological therapy and integrated/collaborative care); probability of cost-effectiveness at explicitly defined thresholds reported. Comparators could be routine practice, no intervention, or alternative psychological therapies. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms. Results were summarized qualitatively. The protocol was registered on the PROSPERO database (CRD42017056579).

Results

Of 3,864 studies identified, 12 met the criteria for data extraction. All were integrated clinical and economic randomized controlled trials. The most common intervention was cognitive behavioral therapy (CBT, 6/12 studies). The most common measure of health benefit was the quality-adjusted life-year (6/12). Follow-up ranged from 6 months to 5 years. Interventions were found to be cost-effective in most studies (9/12): the probability of cost-effectiveness ranged from 35-99.5 percent. All studies had limitations and demonstrated uncertainty (particularly related to incremental costs).

Conclusions

Most studies concluded psychological interventions for schizophrenia/BD are cost-effective, including CBT, although there was notable uncertainty. Heterogeneity across studies makes it difficult to reach strong conclusions. There is a particular need for more evidence in the population with BD and for longer-term evidence across both populations.

Keywords

SchizophreniaBipolar disorderCost-effectivenessCost-utilityEconomic evaluation
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 35 , Issue 4 , 2019 , pp. 317 - 326
Copyright
Copyright © Cambridge University Press 2019 

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References

1.GBD Disease and Injury Incidence and Prevalence Collaborators (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 388, 1545–1602.Google Scholar
2.Hayes, JF, Miles, J, Walters, K, King, M, Osborn, DPJ (2015) A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr Scand 131, 417–425.Google Scholar
3.Brown, S, Kim, M, Mitchell, C, Inskip, H (2010) Twenty-five year mortality of a community cohort with schizophrenia. Br J Psychiatry 196, 116–121.Google Scholar
4.Lawrence, D, Hancock, KJ, Kisely, S (2013) The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: Retrospective analysis of population based registers. BMJ 346, f2539.Google Scholar
5.Saha, S, Chant, D, McGrath, J (2007) A systematic review of mortality in schizophrenia. Arch Gen Psychiatry 64, 1123.Google Scholar
6.Leucht, S, Burkard, T, Henderson, J, Maj, M, Sartorius, N (2007) Physical illness and schizophrenia: A review of the literature. Acta Psychiatr Scand 116, 317–333.Google Scholar
7.Millier, A, Schmidt, U, Angermeyer, MC, et al. (2014) Humanistic burden in schizophrenia: A literature review. J Psychiatr Res Pergamon 54, 85–93.Google Scholar
8.Wahlbeck, K, Westman, J, Nordentoft, M, Gissler, M, Laursen, TM (2011) Outcomes of Nordic mental health systems: Life expectancy of patients with mental disorders. Br J Psychiatry 199, 453–458.Google Scholar
9.Farrelly, S, Clement, S, Gabbidon, J, et al. (2014) Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: A cross sectional study. BMC Psychiatry BioMed Central 14, 157.Google Scholar
10.Thornicroft, G, Brohan, E, Rose, D, et al. (2009) Global pattern of experienced and anticipated discrimination against people with schizophrenia: A cross-sectional survey. Lancet 373, 408–415.Google Scholar
11.Karidi, MV, Vassilopoulou, D, Savvidou, E, et al. (2015) Bipolar disorder and self-stigma: A comparison with schizophrenia. J Affect Disord 184, 209–215.Google Scholar
12.Pattyn, E, Verhaeghe, M, Sercu, C, Bracke, P (2013) Medicalizing versus psychologizing mental illness: What are the implications for help seeking and stigma? A general population study. Soc Psychiatry Psychiatr Epidemiol 48, 1637–1645.Google Scholar
13.Foruzandeh, N, Parvin, N (2013) Occupational therapy for inpatients with chronic schizophrenia: A pilot randomized controlled trial. Japan J Nurs Sci 10, 136–141.Google Scholar
14.Killackey, EJ, Jackson, HJ, Gleeson, J, Hickie, IB, Mcgorry, PD (2006) Exciting career opportunity beckons! Early intervention and vocational rehabilitation in first-episode psychosis: Employing cautious optimism. Aust New Zeal J Psychiatry 40, 951-62.Google Scholar
15.Szkultecka-Dębek, M, Miernik, K, Stelmachowski, J, et al. (2016) Schizophrenia causes significant burden to patients’ and caregivers’ lives. Psychiatr Danub 28, 104–110.Google Scholar
16.Wilens, TE, Biederman, J, Forkner, P, et al. (2003) Patterns of comorbidity and dysfunction in clinically referred preschool and school-age children with bipolar disorder. J Child Adolesc Psychopharmacol 13, 495–505.Google Scholar
17.Carlborg, A, Ferntoft, L, Thuresson, M, Bodegard, J (2015) Population study of disease burden, management, and treatment of bipolar disorder in Sweden: A retrospective observational registry study. Bipolar Disord 17, 76–85.Google Scholar
18.Marwaha, S, Durrani, A, Singh, S (2013) Employment outcomes in people with bipolar disorder: A systematic review. Acta Psychiatr Scand 128, 179–193.Google Scholar
19.Judd, LL, Schettler, PJ, Solomon, DA, et al. (2008) Psychosocial disability and work role function compared across the long-term course of bipolar I, bipolar II and unipolar major depressive disorders. J Affect Disord 108, 49–58.Google Scholar
20.Chong, HY, Teoh, SL, Wu, DB et al. (2016) Global economic burden of schizophrenia: A systematic review. Neuropsychiatr Dis Treat 12, 357–373.Google Scholar
21.McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S (2008) Paying the price: The cost of mental health care in England to 2026 [cited February 12, 2016]. http://www.kingsfund.org.uk/sites/files/kf/Paying-the-Price-the-cost-of-mental-health-care-England-2026-McCrone-Dhanasiri-Patel-Knapp-Lawton-Smith-Kings-Fund-May-2008_0.pdf.sGoogle Scholar
22.Kennedy, JL, Altar, CA, Taylor, DL, Degtiar, I, Hornberger, JC (2014) The social and economic burden of treatment-resistant schizophrenia. Int Clin Psychopharmacol 29, 63–76.Google Scholar
23.McDonagh, MS, Dana, T, Selph, S, et al. (2017) Treatments for Schizophrenia in Adults: A Systematic Review. Rockville, MD: Agency for Healthcare Research and QualityGoogle Scholar
24.Fountoulakis, KN, Vieta, E (2008) Treatment of bipolar disorder: A systematic review of available data and clinical perspectives. Int J Neuropsychopharmacol 11, 999–1029.Google Scholar
25.Pfammatter, M, Junghan, UM, Brenner, HD (2006) Efficacy of psychological therapy in schizophrenia: Conclusions from meta-analyses. Schizophr Bull 32(Suppl 1), S64–S80.Google Scholar
26.Swartz, HA, Swanson, J (2014) Psychotherapy for bipolar disorder in adults: A review of the evidence. Focus (Am Psychiatr Publ) 12, 251–266.Google Scholar
27.The National Institute for Health and Care Excellence (2016) Bipolar disorder in adults. Quality standard [QS95]. and guidelines NICE; [cited December 12, 2018]; https://www.nice.org.uk/guidance/qs95/chapter/Quality-statement-4-developmental-Psychological-interventions.Google Scholar
28.The National Institute for Health and Care Excellence (2016) Psychosis and schizophrenia in adults. Quality standard [QS80]. NICE; [cited December 12, 2018]; https://www.nice.org.uk/guidance/qs80/chapter/Quality-statement-2-Cognitive-behavioural-therapy.Google Scholar
29.Reilly, S, Planner, C, Hann, M, et al. (2012) The role of primary care in service provision for people with severe mental illness in the United Kingdom. Baradaran HR, editor. PLoS One 7, e36468.Google Scholar
30.Amos, A (2012) Assessing the cost of early intervention in psychosis: A systematic review. Aust New Zeal J Psychiatry 46, 719–734.Google Scholar
31.Desmedt, M, Vertriest, S, Hellings, J, et al. (2016) Economic impact of integrated care models for patients with chronic diseases: A systematic review. Value Health 19, 892–902.Google Scholar
32.Abdul Pari, AA, Simon, J, Wolstenholme, J, Geddes, JR, Goodwin, GM (2014) Economic evaluations in bipolar disorder: A systematic review and critical appraisal. Bipolar Disord 16, 557–582.Google Scholar
33.Shields, G, Davies, L, Buck, D, Elvidge, J, Hayhurst, K (2017) A systematic review of cost-effectiveness evaluations of psychological therapies for schizophrenia and bipolar disorder. PROSPERO CRD42017056579. [cited March 3, 2018]. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017056579.Google Scholar
34.Centre for Reviews and Dissemination (2007) NHS Economic Evaluation Database (NHS EED) Handbook 2007 [cited December 18, 2015]. http://www.york.ac.uk/inst//crd/pdf/nhseed-handbook2007.pdf.Google Scholar
35.Husereau, D, Drummond, M, Petrou, S, et al. (2013) Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. BMJ 346, f1049.Google Scholar
36.OECD (2018) Prices - Inflation (CPI) - OECD Data 2018 [cited August 7, 2018]. https://data.oecd.org/price/inflation-cpi.htm.Google Scholar
37.OECD (2018) Purchasing Power Parities (PPPs) Data 2018 [cited August 7, 2018]. https://stats.oecd.org/Index.aspx?DataSetCode=CPL#.Google Scholar
38.Haddock, G, Barrowclough, C, Tarrier, N, et al. (2003) Cognitive-behavioural therapy and motivational intervention for schizophrenia and substance misuse. 18-month outcomes of a randomised controlled trial. Br J Psychiatry 183, 418–426.Google Scholar
39.Barton, GR, Hodgekins, J, Mugford, M, et al. (2009) Cognitive behaviour therapy for improving social recovery in psychosis: Cost-effectiveness analysis. Schizophr Res 112, 158–163.Google Scholar
40.McCrone, P, Craig, TKJ, Power, P, Garety, PA (2010) Cost-effectiveness of an early intervention service for people with psychosis. Br J Psychiatry 196, 377–382.Google Scholar
41.Patel, A, Knapp, M, Romeo, R, et al. (2010) Cognitive remediation therapy in schizophrenia: Cost-effectiveness analysis. Schizophr Res 120, 217–224.Google Scholar
42.van der Gaag, M, Stant, AD, Wolters, KJK, Buskens, E, Wiersma, D (2011) Cognitive-behavioural therapy for persistent and recurrent psychosis in people with schizophrenia-spectrum disorder: Cost-effectiveness analysis. Br J Psychiatry 198, 59–65.Google Scholar
43.Crawford, M, Killaspy, H, Barnes, T, et al. (2012) Group art therapy as an adjunctive treatment for people with schizophrenia: A randomised controlled trial (MATISSE). Health Technol Assess 16, iii-iv, 1–76.Google Scholar
44.Karow, A, Reimer, J, König, HH, et al. (2012) Cost-effectiveness of 12-month therapeutic assertive community treatment as part of integrated care versus standard care in patients with schizophrenia treated with quetiapine immediate release (ACCESS Trial). J Clin Psychiatry 73, e402–e408.Google Scholar
45.Hastrup, LH, Kronborg, C, Bertelsen, M, et al. (2013) Cost-effectiveness of early intervention in first-episode psychosis: Economic evaluation of a randomised controlled trial (the OPUS study). Br J Psychiatry 202, 35–41.Google Scholar
46.Priebe, S, Savill, M, Wykes, T, et al. (2016) Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: A multicentre randomised controlled trial. Health Technol Assess 20, 1–100.Google Scholar
47.Rosenheck, R, Leslie, D, Sint, K, et al. (2016) Cost-effectiveness of comprehensive, integrated care for first episode psychosis in the NIMH RAISE Early Treatment Program. Schizophr Bull 42, 896–906.Google Scholar
48.Camacho, EM, Ntais, D, Jones, S, et al. (2017) Cost-effectiveness of structured group psychoeducation versus unstructured group support for bipolar disorder: Results from a multi-centre pragmatic randomised controlled trial. J Affect Disord 211, 27–36.Google Scholar
49.Lam, DH, McCrone, P, Wright, K, Kerr, N (2005) Cost-effectiveness of relapse-prevention cognitive therapy for bipolar disorder: 30-month study. Br J Psychiatry 186, 500–506.Google Scholar
50.Lenert, L, Sturley, AP, Rapaport, MH, et al. (2004) Public preferences for health states with schizophrenia and a mapping function to estimate utilities from positive and negative symptom scale scores. Schizophr Res 71, 155–165.Google Scholar
51.Shiroiwa, T, Sung, Y-K, Fukuda, T, et al. (2010) International survey on willingness-to-pay (WTP) for one additional QALY gained: What is the threshold of cost effectiveness? Health Econ 19, 422–437.Google Scholar
52.Neumann, PJ, Cohen, JT, Weinstein, MC (2014) Updating cost-effectiveness — The curious resilience of the $50,000-per-QALY threshold. N Engl J Med 371, 796–797.Google Scholar
53.Claxton, K, Martin, S, Soares, M, et al. (2015) Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. Health Technol Assess 19, 1–503, v-vi.Google Scholar
54.Boutron, I, Tubach, F, Giraudeau, B, Ravaud, P (2004) Blinding was judged more difficult to achieve and maintain in nonpharmacologic than pharmacologic trials. J Clin Epidemiol 57, 543–550.Google Scholar
55.National Institute for Health and Care Excellence (2016) Guide to the methods of technology appraisal 2013 NICE; 2013 [cited August 10, 2018]. https://www.nice.org.uk/process/pmg9/chapter/foreword.Google Scholar
56.Nimdet, K, Chaiyakunapruk, N, Vichansavakul, K, Ngorsuraches, S (2015) A systematic review of studies eliciting willingness-to-pay per quality-adjusted life year: Does it justify CE threshold? PLoS One 10, e0122760.Google Scholar
57.Connell, J, O'Cathain, A, Brazier, J (2014) Measuring quality of life in mental health: Are we asking the right questions? Soc Sci Med Pergamon 120, 12–20.Google Scholar
58.Mulhern, B, Mukuria, C, Barkham, M, et al. (2014) Using generic preference-based measures in mental health: Psychometric validity of the EQ-5D and SF-6D. Br J Psychiatry 205, 236–243. http://www.ncbi.nlm.nih.gov/pubmed/24855127Google Scholar
59.Brazier, J (2010) Is the EQ-5D fit for purpose in mental health? Br J Psychiatry 197, 348–349.Google Scholar
60.Subramaniam, M, Abdin, E, Vaingankar, JA, et al. (2013) Impact of psychiatric disorders and chronic physical conditions on health-related quality of life: Singapore Mental Health Study. J Affect Disord 147, 325–330.Google Scholar
61.Konig, H-H, Born, A, Gunther, O, et al. (2010) Validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with anxiety disorders. Health Qual Life Outcomes 8, 47.Google Scholar
62.Hayhurst, H, Palmer, S, Abbott, R, Johnson, T, Scott, J (2006) Measuring health-related quality of life in bipolar disorder: Relationship of the EuroQol (EQ-5D) to condition-specific measures. Qual Life Res 15, 1271–1280.Google Scholar
63.Reininghaus, U, Priebe, S (2012) Measuring patient-reported outcomes in psychosis: Conceptual and methodological review. Br J Psychiatry 201, 262–267.Google Scholar
64.Macpherson, R, Pesola, F, Leamy, M, et al. (2016) The relationship between clinical and recovery dimensions of outcome in mental health. Schizophr Res 175, 142–147.Google Scholar
65.Langer, AI, Schmidt, C, Mayol, R, et al. (2017) The effect of a mindfulness-based intervention in cognitive functions and psychological well-being applied as an early intervention in schizophrenia and high-risk mental state in a Chilean sample: Study protocol for a randomized controlled trial. Trials 18, 233.Google Scholar
66.Bell, CM, Urbach, DR, Ray, JG, et al. (2006) Bias in published cost effectiveness studies: Systematic review. BMJ 332, 699–703.Google Scholar
67.Thorn, JC, Noble, SM, Hollingworth, W (2013) Timely and complete publication of economic evaluations alongside randomized controlled trials. Pharmacoeconomics 31, 77–85.Google Scholar
68.Lal, S, Adair, CE (2014) E-mental health: A rapid review of the literature. Psychiatr Serv 65, 24–32.Google Scholar
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