Skip to main content
×
×
Home

Cost-effectiveness of cognitive–behavioural therapy for sleep disorder added to usual care in patients with schizophrenia: the BEST study

  • Apostolos Tsiachristas (a1), Felicity Waite (a2), Daniel Freeman (a2) and Ramon Luengo-Fernandez (a3)
Abstract
Background

Sleep problems are pervasive in people with schizophrenia, but there are no clinical guidelines for their treatment. The Better Sleep Trial (BEST) concluded that suitably adapted cognitive–behavioural therapy (CBT) is likely to be highly effective, although its cost-effectiveness is unknown.

Aims

To assess the potential cost-effectiveness of CBT for sleep disorders in patients with schizophrenia.

Method

An economic evaluation of the BEST study with a 6-month time horizon was used to establish the cost-effectiveness of CBT plus usual care in terms of costs per quality-adjusted life year (QALY) gained. Uncertainty was displayed on cost-effectiveness planes and acceptability curves. Value of information analysis was performed to estimate the benefits of obtaining further evidence.

Results

On average, the treatment led to a 0.035 QALY gain (95% CI −0.016 to 0.084), and £1524 (95% CI −10 529 to 4736) and £1227 (95% CI −10 395 to 5361) lower costs from National Health Service and societal perspectives, respectively. The estimated value of collecting more information about the effects of the CBT on costs and QALYs was approximately £87 million.

Conclusions

CBT for insomnia in people with schizophrenia is effective and potentially cost-effective. A larger trial is needed to provide clear evidence about its cost-effectiveness.

Relevance

Patients with schizophrenia have multiple complex health needs, as well as very high rates of depression, suicidal ideation and poor physical health. The results of this study showed that treating pervasive sleep problems in this patient group with cognitive–behavioural therapy (CBT) is very likely to improve patient quality of life in the short term. Clinicians most commonly use hypnotic medication to treat sleeping disorders. This study indicates that CBT may be an effective and cost-effective intervention in this patient group. This alternative would also be aligned with patient preferences for psychological and behavioural-type therapy.

Declaration of interest

None.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Cost-effectiveness of cognitive–behavioural therapy for sleep disorder added to usual care in patients with schizophrenia: the BEST study
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Cost-effectiveness of cognitive–behavioural therapy for sleep disorder added to usual care in patients with schizophrenia: the BEST study
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Cost-effectiveness of cognitive–behavioural therapy for sleep disorder added to usual care in patients with schizophrenia: the BEST study
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the CreativeCommons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence: Dr Apostolos Tsiachristas. Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, OX3 7LF, Oxford, UK. E-mail: apostolos.tsiachristas@ndph.ox.ac.uk
References
Hide All
1World Health Organization. The Global Burden of Disease: 2004 Update. WHO, 2008.
2Kirkbride, JB, Errazuriz, A, Croudace, TJ, Morgan, C, Jackson, D, Boydell, J, et al. Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PLoS One 2012; 7(3): e31660.
3Andrew, A, Knapp, M, McCrone, P, Parsonage, M, Trachtenberg, M. Effective Interventions in Schizophrenia the Economic Case: A Report Prepared for the Schizophrenia Commission. Personal Social Service Unit, 2012.
4Hjorthoj, C, Sturup, AE, McGrath, JJ, Nordentoft, M. Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis. Lancet Psychiatry 2017; 4(4): 295301.
5Freeman, D, Pugh, K, Vorontsova, N, Southgate, L. Insomnia and paranoia. Schizophr Res 2009; 108(1–3): 280–4.
6Chouinard, S, Poulin, J, Stip, E, Godbout, R. Sleep in untreated patients with schizophrenia: a meta-analysis. Schizophr Bull 2004; 30(4): 957–67.
7Freeman, D, Waite, F, Startup, H, Myers, E, Lister, R, McInerney, J, et al. Efficacy of cognitive behavioural therapy for sleep improvement in patients with persistent delusions and hallucinations (BEST): a prospective, assessor-blind, randomised controlled pilot trial. Lancet Psychiatry 2015; 2(11): 975–83.
8Docherty, M, Thornicroft, G. Specialist mental health services in England in 2014: overview of funding, access and levels of care. Int J Ment Health Syst 2015; 9: 34.
9National Institute for Health and Care Excellence. Guide to the Methods of Technology Appraisal 2013. NICE, 2013.
10Devlin, N, Shah, K, Feng, Y, Mulhern, B, Van Hout, B. Valuing Health-Related Quality of Life: an EQ-5D-5L Value Set for England. Office of Health Economics, 2016.
11Beecham, J, Knapp, M. Costing psychiatric interventions. In: Measuring Mental Health Needs (ed Thornicroft, G): 200–24. Gaskell, 2001.
12Barton, GR, Briggs, AH, Fenwick, EA. Optimal cost-effectiveness decisions: the role of the cost-effectiveness acceptability curve (CEAC), the cost-effectiveness acceptability frontier (CEAF), and the expected value of perfection information (EVPI). Value Health 2008; 11(5): 886–97.
13Thorn, J, Coast, J, Andronis, L. Interpretation of the expected value of perfect information and research recommendations: a systematic review and empirical investigation. Med Decis Making 2016; 36(3): 285–95.
14Marwaha, S, Johnson, S. Schizophrenia and employment – a review. Soc Psychiatry Psychiatr Epidemiol 2004; 39(5): 337–49.
15Waite, F, Evans, N, Myers, E, Startup, H, Lister, R, Harvey, AG, et al. The patient experience of sleep problems and their treatment in the context of current delusions and hallucinations. Psychol Psychother 2016; 89(2): 181–93.
16Waters, F, Chiu, VW, Janca, A, Atkinson, A, Ree, M. Preferences for different insomnia treatment options in people with schizophrenia and related psychoses: a qualitative study. Front Psychol 2015; 6: 990.
17.Mental Health Taskforce. The Five Year Forward View for Mental Health. NHS England, 2016 (https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf).
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Open
  • ISSN: -
  • EISSN: 2056-4724
  • URL: /core/journals/bjpsych-open
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 25
Total number of PDF views: 146 *
Loading metrics...

Abstract views

Total abstract views: 344 *
Loading metrics...

* Views captured on Cambridge Core between 19th April 2018 - 21st September 2018. This data will be updated every 24 hours.

Cost-effectiveness of cognitive–behavioural therapy for sleep disorder added to usual care in patients with schizophrenia: the BEST study

  • Apostolos Tsiachristas (a1), Felicity Waite (a2), Daniel Freeman (a2) and Ramon Luengo-Fernandez (a3)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *