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Cost-effectiveness of nurse-delivered Cognitive Behavioural Therapy (CBT) compared to Supportive Listening (SL) for adjustment to multiple sclerosis

Research output: Contribution to journalArticle

Original languageEnglish
JournalHealth Economics Review
Issue number36
Early online date10 Oct 2017
StatePublished - 10 Oct 2017


King's Authors


Background: Cognitive Behavioural Therapy (CBT) reduces distress in multiple
sclerosis, and helps manage adjustment, but cost-effectiveness evidence is lacking.
Methods: An economic evaluation was conducted within a multi-centre trial. 94 patients
were randomised to either eight sessions of nurse-led CBT or supportive listening (SL).
Costs were calculated from the health, social and indirect care perspectives, and
combined with additional quality-adjusted life years (QALY) or improvement on the
GHQ-12 score, to explore cost-effectiveness at 12 months.
Results: CBT had higher mean health costs (£1610, 95% CI, -£187 to 3771) and
slightly better QALYs (0.0053, 95% CI, -0.059 to 0.103) compared to SL but these
differences were not statistically significant. This yielded £301,509 per QALY
improvement, indicating that CBT is not cost-effective according to established UK
NHS thresholds. The extra cost per patient improvement on the GHQ-12 scale was
£821 from the same perspective. Using a £20,000, threshold, CBT in this format has a
9% probability of being cost effective. Although subgroup analysis of patients with
clinical levels of distress at baseline showed an improvement in the position of CBT
compared to SL, CBT was still not cost-effective.
Conclusion: Nurse delivered CBT is more effective in reducing distress among MS
patients compared to SL, but is highly unlikely to be cost-effective using a preferencebased
measure of health (EQ-5D). Results from a disease-specific measure (GHQ-12)
produced comparatively lower Incremental Cost-Effectiveness Ratios, but there is
currently no acceptable willingness-to-pay threshold for this measure to guide decisionmaking.

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