title: Cost of improving Access to Psychological Therapies (IAPT) programme: an analysis of cost of session, treatment and recovery in selected Primary Care Trusts in the East of England region.
abstract: Recent literature on Improving Access to Psychological Therapies (IAPT) has reported on improvements in clinical outcomes, changes in employment status and the concept of recovery attributable to IAPT treatment, but not on the costs of the programme. This article reports the costs associated with a single session, completed course of treatment and recovery for four treatment courses (i.e., remaining in low or high intensity treatment, stepping up or down) in IAPT services in 5 East of England region Primary Care Trusts. Costs were estimated using treatment activity data and gross financial information, along with assumptions about how these financial data could be broken down. The estimated average cost of a high intensity session was £177 and the average cost for a low intensity session was £99. The average cost of treatment was £493 (low intensity), £1416 (high intensity), £699 (stepped down), £1514 (stepped up) and £877 (All). The cost per recovered patient was £1043 (low intensity), £2895 (high intensity), £1653 (stepped down), £2914 (stepped up) and £1766 (All). Sensitivity analysis revealed that the costs are sensitive to cost ratio assumptions, indicating that inaccurate ratios are likely to influence overall estimates. Results indicate the cost per session exceeds previously reported estimates, but cost of treatment is only marginally higher. The current cost estimates are supportive of the originally proposed IAPT model on cost-benefit grounds. The study also provides a framework to estimate costs using financial data, especially when programmes have block contract arrangements. Replication and additional analyses along with evidence-based discussion regarding alternative, cost-effective methods of intervention is recommended.
authors.affiliation: NIHR CLAHRC for Cambridgeshire and Peterborough, Cambridge Institute of Public Health, University of Cambridge Forvie Site, Robinson Way, Cambridge CB2 0SR, UK. Electronic address: mrk38@medschl.cam.ac.uk.
authors.forename: Muralikrishnan
authors.initials: M
authors.lastname: Radhakrishnan
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Hammond
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones
authors.forename: Alison
authors.initials: A
authors.lastname: Watson
authors.forename: Fiona
authors.initials: F
authors.lastname: McMillan-Shields
authors.forename: Louise
authors.initials: L
authors.lastname: Lafortune
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000191:economics / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003863:Depression / Q000191:economics / Q000628:therapy; D004651:Employment / Q000706:statistics & numerical data; D004739:England; D019317:Evidence-Based Medicine; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011613:Psychotherapy / Q000191:economics*; D013222:State Medicine / Q000191:economics; D055815:Young Adult