Y Feng1, C Roukas1, M Russo1, S Repišti2, A Džubur Kulenović3, L Injac Stevović4, J Konjufca4, S Markovska-Simoska5, L Novotni6, I Ristić7, E Smajić-Mešević3, F Uka4, M Zebić7, L Vončina8, A Bobinac9, N Jovanović1. 1. Wolfson Institute of Population Health, Queen Mary University of London, London, UK. 2. Psychiatric Clinic, Clinical Centre of Montenegro, Podgorica, Montenegro. 3. Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina. 4. Department of Psychology, University of Pristina, Pristina, Kosovo by United Nations Resolution. 5. Macedonian Academy of Sciences and Arts, Skopje, Republic of North Macedonia. 6. University Clinic of Psychiatry, Skopje, Republic of North Macedonia. 7. Faculty of Medicine, University of Belgrade, Belgrade, Serbia. 8. Faculty of health studies, University of Rijeka, Rijeka, Croatia. 9. Center for Health Economics and Pharmacoeconomics, Faculty of Economics and Business, University of Rijeka, Rijeka, Croatia.
Abstract
BACKGROUND: DIALOG+ is a digital psychosocial intervention aimed at making routine meetings between patients and clinicians therapeutically effective. This study aimed to evaluate the cost-effectiveness of implementing DIALOG+ treatment for patients with psychotic disorders in five low- and middle-income countries in Southeast Europe alongside a cluster randomised trial. METHODS: Resource use and quality of life data were collected alongside the multi-country cluster randomised trial of 468 participants with psychotic disorders. Due to COVID-19 interruptions of the trial's original 12-month intervention period, adjusted costs and quality-adjusted life years (QALYs) were estimated at the participant level using a mixed-effects model over the first 6 months only. We estimated the incremental cost-effectiveness ratio (ICER) with uncertainty presented using a cost-effectiveness plane and a cost-effectiveness acceptability curve. Seven sensitivity analyses were conducted to check the robustness of the findings. RESULTS: The average cost of delivering DIALOG+ was €91.11 per participant. DIALOG+ was associated with an incremental health gain of 0.0032 QALYs (95% CI -0.0015, 0.0079), incremental costs of €84.17 (95% CI -8.18, 176.52), and an estimated ICER of €26,347.61. The probability of DIALOG+ being cost-effective against three times the weighted gross domestic product (GDP) per capita for the five participating countries was 18.9%. CONCLUSION: Evidence from the cost-effectiveness analyses in this study suggested that DIALOG+ involved relatively low costs. However, it is not likely to be cost-effective in the five participating countries compared with standard care against a willingness-to-pay threshold of three times the weighted GDP per capita per QALY gained.
BACKGROUND: DIALOG+ is a digital psychosocial intervention aimed at making routine meetings between patients and clinicians therapeutically effective. This study aimed to evaluate the cost-effectiveness of implementing DIALOG+ treatment for patients with psychotic disorders in five low- and middle-income countries in Southeast Europe alongside a cluster randomised trial. METHODS: Resource use and quality of life data were collected alongside the multi-country cluster randomised trial of 468 participants with psychotic disorders. Due to COVID-19 interruptions of the trial's original 12-month intervention period, adjusted costs and quality-adjusted life years (QALYs) were estimated at the participant level using a mixed-effects model over the first 6 months only. We estimated the incremental cost-effectiveness ratio (ICER) with uncertainty presented using a cost-effectiveness plane and a cost-effectiveness acceptability curve. Seven sensitivity analyses were conducted to check the robustness of the findings. RESULTS: The average cost of delivering DIALOG+ was €91.11 per participant. DIALOG+ was associated with an incremental health gain of 0.0032 QALYs (95% CI -0.0015, 0.0079), incremental costs of €84.17 (95% CI -8.18, 176.52), and an estimated ICER of €26,347.61. The probability of DIALOG+ being cost-effective against three times the weighted gross domestic product (GDP) per capita for the five participating countries was 18.9%. CONCLUSION: Evidence from the cost-effectiveness analyses in this study suggested that DIALOG+ involved relatively low costs. However, it is not likely to be cost-effective in the five participating countries compared with standard care against a willingness-to-pay threshold of three times the weighted GDP per capita per QALY gained.
Entities:
Keywords:
Cluster randomised trial; Cost-effectiveness; DIALOG+; Low- and middle-income countries in Southeast Europe; Psychotic disorders
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