Cognitive remediation therapy in schizophrenia: cost-effectiveness analysis.
OBJECTIVE
There is a lack of evidence on the cost-effectiveness of cognitive remediation therapy (CRT).


METHODS
Randomised controlled trial comparing usual care plus CRT with usual care alone. Participants had a diagnosis of schizophrenia and cognitive and social functioning difficulties. Health/social care and societal costs were estimated at 14 weeks (time 2) and 40 weeks (time 3) after randomisation. The outcome, proportion of participants improving their working memory since baseline, was combined with costs to explore cost-effectiveness.


RESULTS
85 participants were recruited. There were no differences in total health/social care or societal costs between the two groups at either time 2 or time 3. An additional 21% of participants in the CRT group improved their working memory at both follow-ups. When placing these cost and outcomes in hypothetical scenarios concerning how much policy-makers would pay for another 1% of participants improving their working memory, there was more than an 80% chance that CRT would be cost-effective compared to usual care; at time 3, the likelihood of cost-effectiveness peaked at 30% even for investments up to pound 5000.


CONCLUSIONS
CRT can improve memory among people with schizophrenia and cognitive deficits at no additional cost. Although cost-effective in the short term, CRT may have limited potential to save costs in the medium term because it could increase take up of services. This could confer important longer term benefits for the patient group examined here, in terms of improved social functioning and less reliance on services. This can only be ascertained through longer follow-up.
Patel
Anita
A
Centre for the Economics of Mental Health, Health Service and Population Research Department, Box 24, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom. anita.patel@iop.kcl.ac.uk
Knapp
Martin
M
Romeo
Renee
R
Reeder
Clare
C
Matthiasson
Pall
P
Everitt
Brian
B
Wykes
Til
T
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis / Q000191:economics*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011336:Probability; D012559:Schizophrenia / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D013997:Time Factors; D016896:Treatment Outcome