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IAPT is probably not cost-effective

Published online by Cambridge University Press:  02 January 2018

Paul McCrone*
Affiliation:
King's College London, UK. Email: [email protected]
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2013 

The recent economic evaluation of an Improving Access to Psychological Therapies (IAPT) service conducted by Mukuria and colleagues Reference Mukuria, Brazier, Barkham, Connell, Hardy and Hutten1 is a welcome addition to the evidence base pertaining to this programme. This was a non-randomised comparison but it appears that the authors have used appropriate methods to control for differences between areas. A casual reading of the abstract conclusion would lead one to assume that IAPT is likely to be cost-effective. Indeed, the cost per quality-adjusted life year (QALY) is below the upper threshold used by the National Institute for Health and Clinical Excellence (NICE), and below the lower threshold in a sensitivity analysis where the EQ-5D was used. However, the cost per QALY is somewhat misleading. The most useful results from this study are the cost-effectiveness acceptability curves shown in Fig. 2. Here it is revealed that at the NICE upper threshold of £30 000 per QALY, there is about a 38% likelihood that IAPT is cost-effective, increasing to just over 50% if the EQ-5D is used to generate QALYs. If the lower threshold is used, then there is even less chance that IAPT is cost-effective. The overall conclusion of this paper should be based on Fig. 2 and it should be that on the basis of this study IAPT was probably not cost-effective.

References

1 Mukuria, C, Brazier, J, Barkham, M, Connell, J, Hardy, G, Hutten, R, et al Cost-effectiveness of an Improving Access to Psychological Therapies service. Br J Psychiatry 2013; 202: 220–7.CrossRefGoogle ScholarPubMed
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