Cognitive Behavioral Therapy in Early Intervention for Psychosis: A Cost-Effectiveness Analysis

Vollständiger Abstract

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Background: Early intervention for psychosis (EIP) is a multidisciplinary service that treats individuals experiencing early psychosis. Treatment often consists of pharmacotherapy and cognitive behavioral therapy for psychosis (CBTp). While EIP demonstrates clinical efficacy and cost-effectiveness as a comprehensive package, the incremental contribution of its individual components remains unclear. With mental health services facing sustained funding pressures, understanding which EIP elements offer value for money is crucial for resource allocation decisions. Objectives: To evaluate whether CBTp used in conjunction with pharmacotherapy in EIP is cost-effective compared with pharmacotherapy alone. Methods: A cost-effectiveness analysis was conducted using a cohort-based Markov model from the societal perspective over a 3-year time horizon. Model parameters were derived from a targeted literature review. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as the cost per quality-adjusted life-year (QALY) gained. One-way sensitivity analysis identified influential parameters and probabilistic sensitivity analysis (PSA) quantified uncertainty around the ICER. Results: CBTp as an adjunct to pharmacotherapy resulted in a gain of 0.48 QALYs in the base case compared with pharmacotherapy alone. The corresponding ICER was £32 979 per QALY gained. This currently sits above the conventional upper willingness-to-pay threshold of £30 000 per QALY. One-way sensitivity analysis identified cost parameters and utility parameters for symptom-free status as the most influential variables on the ICER. PSA showed that CBTp had approximately a 50% probability of being cost-effective at the £30 000 threshold. Conclusions: Parameter uncertainty, particularly regarding costs and health utilities, drives the marginal cost-effectiveness case for CBTp. The intervention’s proximity to conventional thresholds suggests targeted improvements in service delivery or patient selection could enhance value. CBTp could potentially be a cost-effective adjunct to pharmacotherapy in EIP; however, there is uncertainty around the results of this modeling. These findings support the targeted implementation of CBTp within EIP. Further high-quality long-term studies are recommended to strengthen the evidence base.