title: Cost-Effectiveness of Financial Incentives to Promote Adherence to Depot Antipsychotic Medication: Economic Evaluation of a Cluster-Randomised Controlled Trial.
abstract: BACKGROUND
  Offering a modest financial incentive to people with psychosis can promote adherence to depot antipsychotic medication, but the cost-effectiveness of this approach has not been examined.
  
  
  METHODS
  Economic evaluation within a pragmatic cluster-randomised controlled trial. 141 patients under the care of 73 teams (clusters) were randomised to intervention or control; 138 patients with diagnoses of schizophrenia, schizo-affective disorder or bipolar disorder participated. Intervention participants received £15 per depot injection over 12 months, additional to usual acute, mental and community primary health services. The control group received usual health services. Main outcome measures: incremental cost per 20% increase in adherence to depot antipsychotic medication; incremental cost of 'good' adherence (defined as taking at least 95% of the prescribed number of depot medications over the intervention period).
  
  
  RESULTS
  Economic and outcome data for baseline and 12-month follow-up were available for 117 participants. The adjusted difference in adherence between groups was 12.2% (73.4% control vs. 85.6% intervention); the adjusted costs difference was £598 (95% CI -£4,533, £5,730). The extra cost per patient to increase adherence to depot medications by 20% was £982 (95% CI -£8,020, £14,000). The extra cost per patient of achieving 'good' adherence was £2,950 (CI -£19,400, £27,800). Probability of cost-effectiveness exceeded 97.5% at willingness-to-pay values of £14,000 for a 20% increase in adherence and £27,800 for good adherence.
  
  
  CONCLUSIONS
  Offering a modest financial incentive to people with psychosis is cost-effective in promoting adherence to depot antipsychotic medication. Direct healthcare costs (including costs of the financial incentive) are unlikely to be increased by this intervention.
  
  
  BACKGROUND
  ISRCTN.com 77769281.
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Henderson
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.affiliation: Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
authors.forename: Ksenija
authors.initials: K
authors.lastname: Yeeles
authors.affiliation: Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bremner
authors.affiliation: Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
authors.forename: Sandra
authors.initials: S
authors.lastname: Eldridge
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
authors.affiliation: Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom.
authors.forename: Nicola
authors.initials: N
authors.lastname: O'Connell
authors.affiliation: Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Burns
authors.affiliation: Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom.
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
mesh_terms: D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D009042:Motivation; D011618:Psychotic Disorders / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D014150:Antipsychotic Agents