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A brief cognitive behavioral intervention is cost-effective for primary care patients with medically unexplained physical symptoms compared to usual care
journal contribution
posted on 2023-06-07, 07:49 authored by Harm van MarwijkHarm van Marwijk, Kate SitnikovaObjective: 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.
History
Publication status
- Published
File Version
- Accepted version
Journal
Journal of Psychosomatic ResearchISSN
0022-3999Publisher
ElsevierExternal DOI
Department affiliated with
- Primary Care and Public Health Publications
Full text available
- No
Peer reviewed?
- Yes
Legacy Posted Date
2020-08-28First Open Access (FOA) Date
2021-08-09First Compliant Deposit (FCD) Date
2020-08-28Usage metrics
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