Changes in care costs associated with cognitive behavioural therapy for psychosis delivered in routine clinical practice

Abstract

Background: Schizophrenia spectrum disorders are long-term disabling conditions placing high economic demands on health services.

Aim: To investigate whether cognitive behavioural therapy for psychosis (CBTp), delivered in a specialist psychological therapies service, was associated with a reduction in intensive care costs.

Methods: Days using inpatient care and out of hours crisis support were recorded (N = 69). Costs associated with high intensity care use in the 12 months pre-referral were compared to during, and 12 months following cessation of therapy.

Results: Despite the majority of participants incurring £0 at all time periods, costs of intensive mental health care more than halved with CBTp delivery, with a significant decrease during therapy, and at trend level after therapy (p = 0.07). Post hoc analysis revealed that offsetting the cost of therapy for those who utilised intensive care services at any time point (N = 18) resulted in therapy being cost neutral during therapy and cost effective (at trend level) 12 months following cessation of therapy.

Conclusion: CBTp may reduce costs associated with intensive psychiatric care, even in a population where the minority use these services. Investment in therapy may lead to both clinical and financial benefits.

Keywords:

• Psychosis
• schizophrenia
• cost-analysis
• cognitive behavioural therapy

Acknowledgements

Daniel Stahl was part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Disclosure statement

The authors have no conflict of interest with respect to this publication.

Notes

1 The two different costs relate to different contracts with CCGs depending on volume flow, and not to individual therapist costs. Sessional costs represent an average across the different pay bands of therapists working for the service, and include administrative service costs and trust overheads.

2 This analysis is equivalent to the one carried out for the full sample above, since the Wilcoxon signed rank test excludes cases which exhibit no change across time periods (i.e. those with £0 care costs at all time periods).

Additional information

Funding

DS was partly funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.