Cost-effectiveness of an Improving Access to Psychological Therapies service

Mukuria, Clara; Brazier, John; Barkham, Michael; Connell, Janice; Hardy, Gillian E.; Hutten, Rebecca; Saxon, Dave; Dent‐Brown, Kim; Parry, Glenys

doi:10.1192/bjp.bp.111.107888

Cited by 57 publications

(57 citation statements)

References 13 publications

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“…Our estimated costs for health and social care in the CADET trial are similar to those reported in the IAPT service evaluation for IAPT service or comparator mental health-care services. 76 Furthermore, despite differences in the populations, the QALY gain from the collaborative care intervention is in a similar range to that reported in an evaluation of therapist-delivered cognitive-behavioural therapy for depression, 77 in which the mean incremental QALY benefit was reported as 0.027 (95% CI -0.012 to 0.066).…”

Section: Economic Outcomessupporting

confidence: 52%

“…Although the mean QALY gain is modest, it is comparable, and favourable, to that recently reported in the evaluation of a UK Improving Access to Psychological Therapies (IAPT) service, 76 which estimated a mean EQ-5D QALY gain of 0.014 (SF-6D gain of 0.008). Our estimated costs for health and social care in the CADET trial are similar to those reported in the IAPT service evaluation for IAPT service or comparator mental health-care services.…”

Section: Economic Outcomesmentioning

confidence: 65%

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Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial

Richards

Bower

Chew‐Graham

et al. 2016

Health Technol Assess

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BackgroundCollaborative care is effective for depression management in the USA. There is little UK evidence on its clinical effectiveness and cost-effectiveness.ObjectiveTo determine the clinical effectiveness and cost-effectiveness of collaborative care compared with usual care in the management of patients with moderate to severe depression.DesignCluster randomised controlled trial.SettingUK primary care practices (n = 51) in three UK primary care districts.ParticipantsA total of 581 adults aged ≥ 18 years in general practice with a currentInternational Classification of Diseases, Tenth Edition depressive episode, excluding acutely suicidal people, those with psychosis, bipolar disorder or low mood associated with bereavement, those whose primary presentation was substance abuse and those receiving psychological treatment.InterventionsCollaborative care: 14 weeks of 6–12 telephone contacts by care managers; mental health specialist supervision, including depression education, medication management, behavioural activation, relapse prevention and primary care liaison. Usual care was general practitioner standard practice.Main outcome measuresBlinded researchers collected depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety (General Anxiety Disorder-7) and quality of life (European Quality of Life-5 Dimensions three-level version), Short Form questionnaire-36 items) outcomes at 4, 12 and 36 months, satisfaction (Client Satisfaction Questionnaire-8) outcomes at 4 months and treatment and service use costs at 12 months.ResultsIn total, 276 and 305 participants were randomised to collaborative care and usual care respectively. Collaborative care participants had a mean depression score that was 1.33 PHQ-9 points lower [n = 230; 95% confidence interval (CI) 0.35 to 2.31;p = 0.009] than that of participants in usual care at 4 months and 1.36 PHQ-9 points lower (n = 275; 95% CI 0.07 to 2.64;p = 0.04) at 12 months after adjustment for baseline depression (effect size 0.28, 95% CI 0.01 to 0.52; odds ratio for recovery 1.88, 95% CI 1.28 to 2.75; number needed to treat 6.5). Quality of mental health but not physical health was significantly better for collaborative care at 4 months but not at 12 months. There was no difference for anxiety. Participants receiving collaborative care were significantly more satisfied with treatment. Differences between groups had disappeared at 36 months. Collaborative care had a mean cost of £272.50 per participant with similar health and social care service use between collaborative care and usual care. Collaborative care offered a mean incremental gain of 0.02 (95% CI –0.02 to 0.06) quality-adjusted life-years (QALYs) over 12 months at a mean incremental cost of £270.72 (95% CI –£202.98 to £886.04) and had an estimated mean cost per QALY of £14,248, which is below current UK willingness-to-pay thresholds. Sensitivity analyses including informal care costs indicated that collaborative care is expected to be less costly and more effective. The amount of participant behavioural activation was the only effect mediator.ConclusionsCollaborative care improves depression up to 12 months after initiation of the intervention, is preferred by patients over usual care, offers health gains at a relatively low cost, is cost-effective compared with usual care and is mediated by patient activation. Supervision was by expert clinicians and of short duration and more intensive therapy may have improved outcomes. In addition, one participant requiring inpatient treatment incurred very significant costs and substantially inflated our cost per QALY estimate. Future work should test enhanced intervention content not collaborative care per se.Trial registrationCurrent Controlled Trials ISRCTN32829227.FundingThis project was funded by the Medical Research Council (MRC) (G0701013) and managed by the National Institute for Health Research (NIHR) on behalf of the MRC–NIHR partnership.

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Section: Economic Outcomessupporting

confidence: 52%

Section: Economic Outcomesmentioning

confidence: 65%

Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial

Richards

Bower

Chew‐Graham

et al. 2016

Health Technol Assess

Self Cite

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“…The cost-effectiveness of Improving Access to Psychological Therapies (IAPT) services within the UK is not established [III] (McCrone, 2013;Mukuria et al, 2013). For generalised anxiety disorder, cost-effectiveness studies provide evidence for the value of CBT, certain antidepressants, and pregabalin (Bereza et al, 2009;Heuzenroeder et al, 2004;Iskedjian et al, 2008;Jorgensen et al, 2006;VeraLlonch et al, 2010).…”

Section: Costs Of Illness and Costeffectiveness Of Treatmentmentioning

confidence: 99%

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology

et al. 2014

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This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.

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“…27,28 A recent economic evaluation of an IAPT demonstration site found that IAPT provided a service that was 'probably costeffective' within the usual NICE threshold range of £20 000-£30 000, although with considerable uncertainty surrounding the costs and outcome differences. 29 This evaluation considered the lack of inclusion of medication costs as a study limitation.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Improving Access to Psychological Therapies and antidepressant prescribing rates in England: a longitudinal time-series analysis

Sreeharan

Madden²,

Lee³

et al. 2013

Br J Gen Pract

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BackgroundAntidepressant prescribing rates in England have been increasing since the 1970s. The impact of the Improving Access to Psychological Therapies (IAPT) initiative on antidepressant prescribing rates is unknown. AimTo investigate the impact of the establishment of IAPT services on antidepressant prescribing rates in primary care trusts (PCTs) in England. Design and settingA longitudinal time-series analysis, using PCTlevel data from 2008 to 2011 set in England. MethodA time-series analysis was conducted using PCT-level prescription data, dates of establishment of IAPT services, and covariate data for age, sex, and socioeconomic status. Statistical analysis was carried out using analysis of variance and a random-effect negative binomial model. ResultsAntidepressant prescribing rates in England increased by 10% per year during the study period (adjusted rate ratio = 1.10, 95% CI = 1.09 to 1.10). The implementation of IAPT services had no significant effect on antidepressant prescribing (adjusted rate ratio = 0.99, 95% CI = 0.99 to 1.00). ConclusionIntroduction of a large-scale initiative to increase provision of psychological therapies has not curbed the long-term increased prescribing of antidepressants in England. Keywordsantidepressive agents; cognitive behavioural therapy; depression; general practice; primary health care.

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Cost-effectiveness of an Improving Access to Psychological Therapies service

Cited by 57 publications

References 13 publications

Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial

Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology

Improving Access to Psychological Therapies and antidepressant prescribing rates in England: a longitudinal time-series analysis

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