Abstract/Summary

Background: The Positive Memory Training (PoMeT) trial demonstrated reduced depression symptoms at 3 months for schizophrenia, but its longer-term outcome and cost impacts remain unknown. Methods: Within-trial cost-utility analysis with quality-adjusted life years (QALYs) as outcome based on health-related quality of life (HRQoL) measurement. Secondary outcome anal-yses of capability well-being. The incremental cost-effectiveness of PoMeT was compared to Treatment As Usual only (TAU) over 9 months from the ‘health and social’ care and ‘societal’ perspectives. Uncertainty was explored using bootstrapping and sensitivity analyses for cost out-liers and outcome methods. Results: HRQoL improvement was observed for both PoMeT and TAU at 3 months, but reached statistical significance and was sustained only for TAU. There was no change in capability well-being and no significant group difference in QALYs gained over 9 months. Mean intervention cost was £823. Compared to TAU, PoMeT had significantly higher mental health care costs (+£1251, 95% CI £185 to £2316) during the trial, but ‘health and social care’ and ‘societal’ cost differences were non-significant. Compared to the before-trial period, psychiatric medication costs increased significantly in both groups. The probability of PoMeT being cost-effective at 9 months was <30% and decreased further in sensitivity analyses. Conclusions: PoMeT is unlikely to be cost-effective in the given format. Generalizability remains limited since the before-after cost analysis revealed additional treatment effects also in the TAU group that likely diminished the in-cremental impacts and cost-effectiveness of PoMeT. It is not clear whether an active post-intervention follow-up could result in sustained longer-term effects and improved cost-effectiveness.