Cost-effectiveness of preventing first-episode psychosis in ultra-high-risk subjects: multi-centre randomized controlled trial

H K Ising, F Smit, W Veling, J Rietdijk, S Dragt, R M C Klaassen, N S P Savelsberg, N Boonstra, D H Nieman, D H Linszen, L Wunderink, M van der Gaag*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: Although there is evidence for the effectiveness of interventions for psychosis among ultra-high-risk (UHR) groups, health economic evaluations are lacking. This study aimed to determine the cost effectiveness and cost-utility of cognitive-behavioural therapy (CBT) to prevent first-episode psychosis.

METHOD: The Dutch Early Detection and Intervention Evaluation study was a randomized controlled trial of 196 UHR patients with an 18-month follow-up. All participants were treated with routine care (RC) for non-psychotic disorders. The experimental group (n = 95) received add-on CBT to prevent first-episode psychosis. We report the intervention, medical and travel costs, as well as costs arising from loss of productivity. Treatment response was defined as psychosis-free survival and quality-adjusted life years (QALYs) gained.

RESULTS: In the cost-effectiveness analysis, the proportion of averted psychoses was significantly higher in the CBT condition (89.5% v. 76.2%). CBT showed a 63.7% probability of being more cost effective, because it was less costly than RC by US$844 (£551) per prevented psychosis. In the cost-utility analysis, QALY health gains were slightly higher for CBT than for RC (0.60 v. 0.57) and the CBT intervention had a 52.3% probability of being the superior treatment because, for equal or better QALY gains, the costs of CBT were lower than those of RC.

CONCLUSIONS: Add-on preventive CBT for UHR resulted in a significant reduction in the incidence of first psychosis. QALY gains show little difference between the two conditions. The CBT intervention proved to be cost saving.

Original languageEnglish
Pages (from-to)1435-46
Number of pages12
JournalPsychological Medicine
Issue number7
Publication statusPublished - May 2015


  • Adolescent
  • Adult
  • Cognitive Therapy
  • Cost-Benefit Analysis
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Outcome Assessment (Health Care)
  • Psychotic Disorders
  • Quality-Adjusted Life Years
  • Risk
  • Young Adult

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