Objective: The aim of this service evaluation was to explore the effectiveness of a psychotherapeutic treatment for patients with epilepsy based on the Acceptance and Commitment Therapy (ACT) approach and to assess whether this treatment is likely to be cost-effective. Method:We conducted an uncontrolled prospective study of consecutive patients with refractory epilepsy referred for outpatient psychological treatment to a single psychotherapist because of emotional difficulties related to their seizure disorder. Participants were referred by consultant neurologists, neuropsychologists or epilepsy nurses and completed a set of validated self-report questionnaires (Short Form -12 Version 2, Generalised Anxiety Disorder -7, Neurological Disorders Depression Inventory for Epilepsy, Work and Social Adjustment Scale, and Rosenberg Self-Esteem Scale) at referral, the end of therapy and six months post therapy. Patients received a maximum of 20 sessions of one-to-one psychological treatment supported by a workbook. Cost-effectiveness was estimated based on the calculation of quality-adjusted life year (QALY) gains associated with the intervention.Results: Sixty patients completed the pre-and post-psychotherapy questionnaires, 41 also provided six-month follow-up data. Patients received six to 20 sessions of psychotherapy (mean = 11.5, S.D. = 9.6). Psychotherapy was associated with significant medium to large positive effects on depression, anxiety, quality of life, self-esteem, work and social adjustment (Ps < .001), which were sustained six months after therapy. The mean cost of the psychotherapy was £445.6 and, assuming that benefits were maintained for at least six months after the end of therapy, the cost per QALY was estimated to be £11,140 ( 9, $18,016; the cost per QALY would be half this amount if the benefits lasted one year). Conclusion:The findings of this pilot study indicate that the described psychotherapeutic intervention may be a cost-effective treatment for patients with epilepsy. The results suggest that randomised controlled trial of the psychotherapy programme is justified.