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Cost-effectiveness of nurse-delivered cognitive behavioural therapy (CBT) compared to supportive listening (SL) for adjustment to multiple sclerosis

Author

Listed:
  • I. Mosweu

    (King’s College London)

  • R. Moss-Morris

    (King’s College London)

  • L. Dennison

    (University of Southampton)

  • T. Chalder

    (King’s College London)

  • P. McCrone

    (King’s College London)

Abstract

Background Cognitive Behavioural Therapy (CBT) reduces distress in multiple sclerosis, and helps manage adjustment, but cost-effectiveness evidence is lacking. Methods An economic evaluation was conducted within a multi-centre trial. 94 patients were randomised to either eight sessions of nurse-led CBT or supportive listening (SL). Costs were calculated from the health, social and indirect care perspectives, and combined with additional quality-adjusted life years (QALY) or improvement on the GHQ-12 score, to explore cost-effectiveness at 12 months. Results CBT had higher mean health costs (£1610, 95% CI, −£187 to 3771) and slightly better QALYs (0.0053, 95% CI, −0.059 to 0.103) compared to SL but these differences were not statistically significant. This yielded £301,509 per QALY improvement, indicating that CBT is not cost-effective according to established UK NHS thresholds. The extra cost per patient improvement on the GHQ-12 scale was £821 from the same perspective. Using a £20,000, threshold, CBT in this format has a 9% probability of being cost effective. Although subgroup analysis of patients with clinical levels of distress at baseline showed an improvement in the position of CBT compared to SL, CBT was still not cost-effective. Conclusion Nurse delivered CBT is more effective in reducing distress among MS patients compared to SL, but is highly unlikely to be cost-effective using a preference-based measure of health (EQ-5D). Results from a disease-specific measure (GHQ-12) produced comparatively lower Incremental Cost-Effectiveness Ratios, but there is currently no acceptable willingness-to-pay threshold for this measure to guide decision-making.

Suggested Citation

  • I. Mosweu & R. Moss-Morris & L. Dennison & T. Chalder & P. McCrone, 2017. "Cost-effectiveness of nurse-delivered cognitive behavioural therapy (CBT) compared to supportive listening (SL) for adjustment to multiple sclerosis," Health Economics Review, Springer, vol. 7(1), pages 1-9, December.
    • Handle: RePEc:spr:hecrev:v:7:y:2017:i:1:d:10.1186_s13561-017-0172-4
    DOI: 10.1186/s13561-017-0172-4
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    References listed on IDEAS

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    1. Brazier, John & Ratcliffe, Julie & Salomon, Joshua & Tsuchiya, Aki, 2016. "Measuring and Valuing Health Benefits for Economic Evaluation," OUP Catalogue, Oxford University Press, edition 2, number 9780198725923.
    2. Alan Williams, 1995. "The role of the Euroqol instrument in QALY calculations," Working Papers 130chedp, Centre for Health Economics, University of York.
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    1. B. Rodríguez-Sánchez & S. Daugbjerg & L. M. Peña-Longobardo & J. Oliva-Moreno & I. Aranda-Reneo & A. Cicchetti & J. López-Bastida, 2023. "Does the inclusion of societal costs change the economic evaluations recommendations? A systematic review for multiple sclerosis disease," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(2), pages 247-277, March.

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