Cognitive remediation therapy in schizophrenia: Cost-effectiveness analysis

Patel, Anita; Knapp, Martin; Romeo, Renee; Reeder, Clare; Matthiasson, Pall; Everitt, Brian; Wykes, Til

doi:10.1016/j.schres.2009.12.003

« Previous Next »Schizophrenia Research
Volume 120, Issue 1 , Pages 217-224, July 2010

Cognitive remediation therapy in schizophrenia: Cost-effectiveness analysis

Anita Patel
- Centre for the Economics of Mental Health, Health Service and Population Research Department, Box 24, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
Martin Knapp
- Centre for the Economics of Mental Health, Health Service and Population Research Department, Box 24, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom
Renee Romeo
- Centre for the Economics of Mental Health, Health Service and Population Research Department, Box 24, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
- Corresponding author. Tel.: +44 20 7848 0588; fax: +44 20 7848 0458.
Clare Reeder
- Department of Psychology, Box 77, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
Pall Matthiasson
- Section of Neuroimaging, Box 67, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
Brian Everitt
- Department of Biostatistics and Computing, Box 20, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
Til Wykes
- Department of Psychology, Box 77, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom

Received 4 June 2009; received in revised form 26 October 2009; accepted 3 December 2009. published online 07 January 2010.

Abstract

Purpose

There is a lack of evidence on the cost-effectiveness of cognitive remediation therapy (CRT).

Methods

Randomised controlled trial comparing usual care plus CRT with usual care alone. Participants had a diagnosis of schizophrenia and cognitive and social functioning difficulties. Health/social care and societal costs were estimated at 14weeks (time 2) and 40weeks (time 3) after randomisation. The outcome, proportion of participants improving their working memory since baseline, was combined with costs to explore cost-effectiveness.

Results

85 participants were recruited. There were no differences in total health/social care or societal costs between the two groups at either time 2 or time 3. An additional 21% of participants in the CRT group improved their working memory at both follow-ups. When placing these cost and outcomes in hypothetical scenarios concerning how much policy-makers would pay for another 1% of participants improving their working memory, there was more than an 80% chance that CRT would be cost-effective compared to usual care; at time 3, the likelihood of cost-effectiveness peaked at 30% even for investments up to £5000.

Conclusions

CRT can improve memory among people with schizophrenia and cognitive deficits at no additional cost. Although cost-effective in the short term, CRT may have limited potential to save costs in the medium term because it could increase take up of services. This could confer important longer term benefits for the patient group examined here, in terms of improved social functioning and less reliance on services. This can only be ascertained through longer follow-up.

Keywords: Cognitive remediation, Psychological therapy, Cost-effectiveness