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Cost-effectiveness of financial incentives to promote adherence to depot antipsychotic medication: economic evaluation of a cluster-randomised controlled trial

Henderson, Catherine, Knapp, Martin, Yeeles, Ksenija, Bremner, Stephen, Eldridge, Sandra, David, Anthony S., O’Connell, Nicola, Burns, Tom and Priebe, Stefan (2015) Cost-effectiveness of financial incentives to promote adherence to depot antipsychotic medication: economic evaluation of a cluster-randomised controlled trial. PLOS ONE, 10 (10). e0138816. ISSN 1932-6203

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Identification Number: 10.1371/journal.pone.0138816

Abstract

Background Offering a modest financial incentive to people with psychosis can promote adherence to depot antipsychotic medication, but the cost-effectiveness of this approach has not been examined. Methods Economic evaluation within a pragmatic cluster-randomised controlled trial. 141 patients under the care of 73 teams (clusters) were randomised to intervention or control; 138 patients with diagnoses of schizophrenia, schizo-affective disorder or bipolar disorder participated. Intervention participants received £15 per depot injection over 12 months, additional to usual acute, mental and community primary health services. The control group received usual health services. Main outcome measures: incremental cost per 20% increase in adherence to depot antipsychotic medication; incremental cost of ‘good’ adherence (defined as taking at least 95% of the prescribed number of depot medications over the intervention period). Findings Economic and outcome data for baseline and 12-month follow-up were available for 117 participants. The adjusted difference in adherence between groups was 12.2% (73.4% control vs. 85.6% intervention); the adjusted costs difference was £598 (95% CI -£4 533, £5 730). The extra cost per patient to increase adherence to depot medications by 20% was £982 (95% CI -£8 020, £14 000). The extra cost per patient of achieving 'good' adherence was £2 950 (CI -£19 400, £27 800). Probability of cost-effectiveness exceeded 97.5% at willingness-to-pay values of £14 000 for a 20% increase in adherence and £27 800 for good adherence. Interpretation Offering a modest financial incentive to people with psychosis is cost-effective in promoting adherence to depot antipsychotic medication. Direct healthcare costs (including costs of the financial incentive) are unlikely to be increased by this intervention.

Item Type: Article
Official URL: http://www.plosone.org/
Additional Information: © 2015 The Authors
Divisions: Personal Social Services Research Unit
Subjects: H Social Sciences > HV Social pathology. Social and public welfare. Criminology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RT Nursing
R Medicine > RZ Other systems of medicine
Sets: Research centres and groups > Personal Social Services Research Unit (PSSRU)
Date Deposited: 09 Nov 2015 15:42
Last Modified: 20 Mar 2019 02:44
Projects: 07/60/43
Funders: National Institute for Health Research
URI: http://eprints.lse.ac.uk/id/eprint/64376

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