Cognitive behavioral therapy for psychosis: a cost-effectiveness study using the EPiSODe model
Konings, Stefan RA Berkhof, Maureen Veling, Wim Visser, Ellen Mierau, Jochen Feenstra, Talitha Bruggeman, Richard
Konings, Stefan RA
Berkhof, Maureen
Veling, Wim
Visser, Ellen
Mierau, Jochen
Feenstra, Talitha
Bruggeman, Richard
Series / Report no.
Open Access
Type
Journal Article
Article
Article
Language
en
Date of publication
2025-06-30
Year of publication
Research Projects
Organizational Units
Journal Issue
Title
Cognitive behavioral therapy for psychosis: a cost-effectiveness study using the EPiSODe model
Translated Title
Published in
Eur Psychiatry 2025; 68(1):e150
Abstract
BACKGROUND: Cognitive Behavioural Therapy for psychosis (CBTp) is an effective psychological treatment for Schizophrenia Spectrum and other psychotic Disorders (SSD). Despite guidelines recommending CBTp for all psychotic disorder patients, many SSD patients lack access to the treatment and little is known about its long-term cost-effectiveness. The aim of this study is to evaluate the cost-effectiveness of CBTp for the treatment of psychotic disorders through scenario analysis from a healthcare perspective.
METHODS: Increased implementation of CBTp was evaluated using a real-world SSD population ( = 12,835) from the northern Netherlands (2010-2019). A patient-level model was used to simulate the long-term effects of rehospitalisation rate. We compared treatment as usual (TAU) with the same TAU plus hypothetical CBTp for all individuals not having received such in TAU, hence patients who received any CBTp sessions prior were excluded ( = 2,679). Outcomes considered were quality-adjusted life years gained and total costs of mental healthcare. Additional sensitivity and scenario analyses were performed to evaluate structural and parameter uncertainty.
RESULTS: TAU+CBTp was a cost-effective treatment in 61.2% of the simulations. The simulated net present values for QALY gains were 0.038, and for incremental costs were €492 per patient on average, resulting in an expected incremental cost-effectiveness ratio (ICER) of €12,947.
CONCLUSIONS: The evaluation shows that CBTp is likely a cost-effective treatment, although results were uncertain. These findings stress the importance of sufficient availability of CBTp for SSD patients. Making CBTp available for all eligible SSD patients may lead to substantial health gains for the SSD population and cost savings from the healthcare perspective in The Netherlands.