title: Cost-effectiveness of adherence therapy versus health education for people with schizophrenia: randomised controlled trial in four European countries.
abstract: BACKGROUND
  Non-adherence to anti-psychotics is common, expensive and affects recovery. We therefore examine the cost-effectiveness of adherence therapy for people with schizophrenia by multi-centre randomised trial in Amsterdam, London, Leipzig and Verona.
  
  
  METHODS
  Participants received 8 sessions of adherence therapy or health education. We measured lost productivity and use of health/social care, criminal justice system and informal care at baseline and one year to estimate and compare mean total costs from health/social care and societal perspectives. Outcomes were the Short Form 36 (SF-36) mental component score (MCS) and quality-adjusted life years (QALYs) gained (SF-36 and EuroQoL 5 dimension (EQ5D)). Cost-effectiveness was examined for all cost and outcome combinations using cost-effectiveness acceptability curves (CEACs).
  
  
  RESULTS
  409 participants were recruited. There were no cost or outcome differences between adherence therapy and health education. The probability of adherence therapy being cost-effective compared to health education was between 0.3 and 0.6 for the six cost-outcome combinations at the willingness to pay thresholds we examined.
  
  
  CONCLUSIONS
  Adherence therapy appears equivalent to health education. It is unclear whether it would have performed differently against a treatment as usual control, whether such an intervention can impact on quality of life in the short-term, or whether it is likely to be cost-effective in some sites but not others.
  
  
  BACKGROUND
  Trial registration: Current Controlled Trials ISRCTN01816159.
authors.affiliation: Centre for the Economics of Mental & Physical Health, PO 24, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, United Kingdom. anita.patel@kcl.ac.uk.
authors.forename: Anita
authors.initials: A
authors.lastname: Patel
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.forename: Morven
authors.initials: M
authors.lastname: Leese
authors.forename: Francesco
authors.initials: F
authors.lastname: Amaddeo
authors.forename: Michele
authors.initials: M
authors.lastname: Tansella
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kilian
authors.forename: Matthias
authors.initials: M
authors.lastname: Angermeyer
authors.forename: Martijn
authors.initials: M
authors.lastname: Kikkert
authors.forename: Aart
authors.initials: A
authors.lastname: Schene
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp