title: The Cost-Effectiveness of Cognitive-Behavioral Group Training for Patients with Unexplained Physical Symptoms.
abstract: OBJECTIVE
  The aim of the study was to evaluate the cost-effectiveness of a cognitive-behavioral group training compared with a wait-list control for patients with unexplained physical symptoms (UPS).
  
  
  METHODS
  A probabilistic decision-analytic Markov model was developed with three health states (poor health, average health, and death) based on a cutoff score of the Physical Component Summary of the short-form 36 health survey. To assess the cost-effectiveness in terms of cost per quality-adjusted life-year (QALY), a societal perspective was adopted. The model consisted of cycles of 3 months and a time horizon of 4 years. Data for the model were derived from a randomized controlled trial, in which 162 patients with UPS were randomized either to cognitive-behavioral group training or to the wait-list control. Data were assessed at baseline and after the training of 3 months or after a wait-list period of 3 months. In addition, the training group was followed in an uncontrolled phase and assessed at 3 months and 1 year after the training.
  
  
  RESULTS
  After 4 years, the group training was in terms of cost-effectiveness "dominant" compared with the wait-list control; there was a positive effect of 0.06 QALYs and a €828 reduction in costs. The cost-effectiveness improved with a longer time horizon. A threshold of €30,000/QALY was passed after 18 months. The group training was cost saving after 33 months.
  
  
  CONCLUSIONS
  Cognitive-behavioral group training is a cost-effective treatment compared with the wait-list control for patients with UPS.
authors: Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: m.s.visser@erasmusmc.nl.
authors: Martijn S
authors: MS
authors: Visser
authors: Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands; Departments of Anesthesiology and Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.
authors: Lyonne N L
authors: LN
authors: Zonneveld
authors: Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Adriaan
authors: A
authors: Van't Spijker
authors: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Myriam G
authors: MG
authors: Hunink
authors: Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Jan J V
authors: JJ
authors: Busschbach
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D011336:Probability; D011615:Psychotherapy, Group / Q000191:economics*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Unexplained physical symptoms; cost-effectiveness; quality-adjusted life-year