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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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