A brief cognitive behavioural intervention is cost-effective for primary care patients with medically unexplained physical symptoms compared to usual care

Kate Sitnikova, Aureliano P. Finch, Stephanie S. Leone, Judith E. Bosmans, Harm W.J. van Marwijk, Henriëtte E. van der Horst, Johannes C. van der Wouden

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2 Citations (Scopus)

Abstract

Objective: To assess the cost-effectiveness of a brief cognitive behavioural intervention for patients with medically unexplained physical symptoms (MUPS) provided by a mental health nurse practitioner (MHNP) in primary care in comparison with usual care. Methods: We performed an economic evaluation from a societal perspective alongside a cluster randomised controlled trial with 12 months follow-up. The primary outcome was quality-adjusted life-years (QALYs). Secondary outcomes were the RAND-36 physical component summary score (PCS), somatic symptom severity (Patient Health Questionnaire (PHQ-15), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale (HADS)). Missing data were imputed using multiple imputation. We used non-parametric bootstrapping to estimate statistical uncertainty. The bootstrapped cost-effect pairs were used to estimate cost-effectiveness planes and cost-effectiveness acceptability curves. Results: Mean total costs in the intervention group were significantly lower than in the usual care group (mean difference − 2300€, 95% CI -3257 to −134). The mean difference in QALYs was 0.01 (95% CI −0.01 to 0.04), in PCS 2.46 (95% CI 1.44 to 3.47), in PHQ-15 -0.26 (95% CI -0.81 to 0.28), and in HADS -0.07 (−0.81 to 0.67). At a willingness to pay of 0 € per additional unit of effect, the probability of the intervention being cost-effective was 0.93 for QALYs and 0.92 for PCS, PHQ-15 and HADS scores. Conclusion: Our intervention is cost-effective compared to usual care for patients with MUPS. Implementation of the intervention has the potential to result in a significant decline in costs. However, large scale implementation would require increased deployment of MHNPs.

Original languageEnglish
Article number110217
Pages (from-to)1-10
Number of pages10
JournalJournal of psychosomatic research
Volume138
Early online date27 Aug 2020
DOIs
Publication statusPublished - Nov 2020

Keywords

  • Cognitive behavioural therapy (CBT)
  • Cost-effectiveness
  • General practice
  • Medically unexplained physical symptoms
  • Primary care

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