Four-Year Cost-effectiveness of Cognitive Behavior Therapy for Preventing First-episode Psychosis: The Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial.
This study aims to evaluate the long-term cost-effectiveness of add-on cognitive behavior therapy (CBT) for the prevention of psychosis for individuals at ultrahigh risk (UHR) of psychosis.



The Dutch Early Detection and Intervention randomized controlled trial was used, comparing routine care (RC; n = 101) with routine care plus CBT for UHR (here called CBTuhr; n = 95). A cost-effectiveness analysis was conducted with treatment response (defined as proportion of averted transitions to psychosis) as an outcome and a cost-utility analysis with quality-adjusted life years (QALYs) gained as a secondary outcome.



The proportion of averted transitions to psychosis was significantly higher in the CBTuhr condition (with a risk difference of 0.122; b = 1.324, SEb = 0.017, z = 7.99, P < 0.001). CBTuhr showed an 83% probability of being more effective and less costly than RC by -US$ 5777 (savings) per participant. In addition, over the 4-year follow-up period, cumulative QALY health gains were marginally (but not significantly) higher in CBTuhr than for RC (2.63 vs. 2.46) and the CBTuhr intervention had a 75% probability of being the superior treatment (more QALY gains at lower costs) and a 92% probability of being cost-effective compared with RC at the Dutch threshold value (US$ 24 560; €20 000 per QALY).



Add-on preventive CBTuhr had a high likelihood (83%) of resulting in more averted transitions to psychosis and lower costs as compared with RC. In addition, the intervention had a high likelihood (75%) of resulting in more QALY gains and lower costs as compared to RC.
Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands.
Helga K
HK
Ising
Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.|Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.
Joran
J
Lokkerbol
Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands.|Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
Judith
J
Rietdijk
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
Sara
S
Dragt
Child and Adolescent Department, University Medical Center, Utrecht, The Netherlands.
Rianne M C
RM
Klaassen
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
Tamar
T
Kraan
Department of Research and Education, Friesland Mental Health Services, Leeuwarden, The Netherlands.
Nynke
N
Boonstra
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
Dorien H
DH
Nieman
Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands.
David P G
DP
van den Berg
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
Don H
DH
Linszen
Department of Research and Education, Friesland Mental Health Services, Leeuwarden, The Netherlands.
Lex
L
Wunderink
Department of Psychiatry, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
Wim
W
Veling
Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.|Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.|Department of Public Mental Health, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.
Filip
F
Smit
Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands.|Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
Mark
M
van der Gaag
D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D011618:Psychotic Disorders / Q000191:economics* / Q000517:prevention & control*; D012306:Risk; D055815:Young Adult
cost-effectiveness; cost-utility; prevention; psychosis; quality-adjusted life year (QALY); ultra-high risk