The Cost-Effectiveness of the Improving Access to Psychological Therapies (IAPT) Programme in Severe Mental Illness: A Decision Analytical Model Using Routine Data

Zala, Darshan; Brabban, Alison; Stirzaker, Alex; Kartha, Muralikrishnan R.; McCrone, Paul

doi:10.1007/s10597-019-00390-z

Cited by 6 publications

(7 citation statements)

References 24 publications

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“…Patients with psychosis or bipolar disorder 1 UK (1/1, 100.0%) [18] Very serious limitations (1/1, 100.0%) [18] The UK study [18] found that compared to the current practice, use of the Improving Access to Psychological Therapies Programme resulted in an ICER of £12.9 per WSAS (Work and Social Adjustment Scale) point.…”

Section: Study Quality Summary Of Results Conclusionmentioning

confidence: 99%

“…In terms of population, the majority of included studies related to people with a diagnosis of schizophrenia (68/73, 93.2%). The remaining studies evaluated interventions for people with a non-specific diagnosis of psychosis (5/73, 6.8%) [1,[15][16][17][18] and those at CHR (2/73, 2.7%) [15,17]. In terms of interventions assessed, most included studies compared the costeffectiveness of different antipsychotics versus each other, placebo or nothing (57/73, 78.1%).…”

Section: Study Descriptionsmentioning

confidence: 99%

“…In terms of interventions assessed, most included studies compared the costeffectiveness of different antipsychotics versus each other, placebo or nothing (57/73, 78.1%). The remaining studies assessed the cost-effectiveness of different coverage of Medicare drug plans (1/53, 1.6%) [19], electroconvulsive therapy (ECT) versus antipsychotic (1/53, 1.6%) [20], precision medicine test versus no test (4/73, 5.5%) [21][22][23][24], different monitoring schedules for patients receiving clozapine (1/73, 1.4%) [25], antipsychotics versus antipsychotics plus psychosocial interventions (5/73, 6.8%) [26][27][28][29][30], CBT versus no CBT (1/73, 1.4%) [17], improving patients' access to psychological therapies versus no intervention (1/73, 1.4%) [18], supported employment programme vs no intervention (1/73, 1.4%) [1], and different modes of liaison between primary and secondary care services (1/53, 1.6%) [15]. The availability of economic evidence across the schizophrenia care pathway is presented in Fig.…”

Section: Study Descriptionsmentioning

confidence: 99%

“…• A programme to improve patients' access to psychological therapies, compared to current practice [18];…”

Section: Conclusion For Non-pharmacological Interventionsmentioning

confidence: 99%

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A Systematic Review of Economic Models Across the Entire Schizophrenia Pathway

et al. 2020

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Background: Schizophrenia is associated with a high economic burden. Economic models can help to inform resource allocation decisions to maximise benefits to patients.Objectives: This systematic review aims to assess the availability, quality and consistency of conclusions of health economic models evaluating the cost-effectiveness of interventions for schizophrenia. Methods: An electronic search was performed on multiple databases (MEDLINE, EMBASE, PsycInfo, Cochrane database of systematic reviews, NHS Economic Evaluation Database and Health Technology Assessment database) to identify economic models of interventions for schizophrenia published between 2005-2020. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) checklist and the Cooper hierarchy. Model characteristics and conclusions were descriptively summarised. Results: Seventy-three models met inclusion criteria. 78% of existing models assessed antipsychotics, however, due to inconsistent conclusions reported by different studies, no antipsychotic can be considered clearly costeffective compared with the others. A very limited number of models suggest that the following nonpharmacological interventions might be cost-effective: psychosocial interventions, stratified tests, employment intervention and intensive intervention to improve liaison between primary and secondary care. The quality of included models is generally low due to use of a short time horizon, omission of adverse events of interventions, poor data quality and potential conflicts of interest.Conclusions: This review highlights a lack of models for non-pharmacological interventions, and limitations of the existing models, including low quality and inconsistency in conclusions. Recommendations on future modelling approaches for schizophrenia are provided. Key Points for Decision Makers• This is the first systematic review of model-based economic analyses which covers the entire schizophrenia care pathway, by including any intervention for the prevention, detection, diagnosis, treatment and follow-up of schizophrenia.• This review highlights a lack of models for non-pharmacological interventions, and low quality of existing models. Common reasons for low-quality include use of a time-horizon which is not sufficiently long, failure to capture the health and cost impact of adverse events of the interventions under assessment, and potential conflicts of interest.• Due to inconsistent conclusions reported by different studies, no antipsychotic can be considered clearly cost-effective compared with the others. A very limited number of models suggest that the following non-pharmacological interventions might be cost-effective: psychosocial interventions, stratified tests, employment intervention and intensive intervention to improve liaison between primary and secondary care.• A consistent basis for the model structure, use of evidence and assumptions in health economic models is required in order to i...

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Section: Study Quality Summary Of Results Conclusionmentioning

confidence: 99%

Section: Study Descriptionsmentioning

confidence: 99%

Section: Study Descriptionsmentioning

confidence: 99%

“…• A programme to improve patients' access to psychological therapies, compared to current practice [18];…”

Section: Conclusion For Non-pharmacological Interventionsmentioning

confidence: 99%

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A Systematic Review of Economic Models Across the Entire Schizophrenia Pathway

et al. 2020

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“…A recent report by King's College London 46 found that offering evidence based psychological interventions for people given a diagnosis of personality disorder costs an average of £751 more than existing services per episode. Participants in this study demonstrated an immediate reduction in self harming and suicidal behaviour alongside a reduction in violent incidents.…”

Section: Let`s Use Limited Resources To the Best Effectmentioning

confidence: 99%

References

2022

Personality Disorder

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Consensus statement: People with complex mental health difficulties who are diagnosed with a Personality Disorder Shining lights in dark corners of people`s lives "I have come across countless individuals and families, in my work as a minister and as an MP, who have been let down by mental health services. There has been some encouraging progress over the last few years, with mental health gradually brought out of the shadows and more people accessing treatment. But I am still horrified at the scandalous neglect and exclusion of those given a diagnosis of 'personality disorder' . "The disadvantages they face -not just in the NHS, but in wider society -are clear. Lower life expectancy, inadequate access to treatment, barriers to employment, and a lack of awareness in society. This is especially unjust when we know what approaches are effective in supporting people to live more fulfilling lives. "This consensus statement is a call to action to stop the appalling treatment which people given a diagnosis of Personality Disorder too often experience. It is intolerable that the services we offer do not meet the needs of this group of people, when small changes could make such a difference. This report offers some important suggestions which offer hope to these people. It is vital that government and the NHS grasps the urgency of this."

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