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Gold, incentives and meh

IAPT – a summary of the evidence to date

See below for a summary of the published evidence on Improving Access to Psychological Therapies so far.

Mukuria C et al. Cost-effectiveness of an Improving Access to Psychological Therapies service.

Looked at the cost-effectiveness of IAPT at the Doncaster demonstration site over the study period from 2007–2009, relative to comparator sites.

Found the cost per QALY gained was £29,500 based on relative improvements on the SF-6D questionnaire, but confidence intervals were wide and there was less than a 40% chance IAPT would be cost-effective at the £30,000 NICE upper limit.

Br J Psych 2013; 202: 220–227 

Radhakrishnan M et al. Cost of Improving Access to Psychological Therapies (IAPT) programme: An analysis of cost of session, treatment and recovery in selected Primary Care Trusts in the East of England region.

Study evaluating the cost per session, completed treatment and recovered patient using financial data from five PCTs in the East of England region. Estimated cost of a high-intensity session was £177, while the average cost of a low-intensity session was £99.

Average costs of treatment were: £493 (low intensity); £1,416 (high intensity); £699 (stepped down); £1,514 (stepped up) and £877 (all).

Average costs per recovered patient were £1,043 (low intensity), £2,895 (high intensity), £1,653 (stepped down), £2,914 (stepped up) and £1,766 (all).

Authors concluded the costs of treatment were higher than original estimates laid out in advance of the IAPT programme (eg, £750 for overall cost of completed treatment) – but ‘only marginally’ so, and their findings therefore ‘support the original proposed model on cost-benefit grounds’.

Behav Res Ther 2013; 51: 37–45 

Gyani A et al. Enhancing recovery rates: Lessons from year one of IAPT.

Evaluation of results after the first year of IAPT roll-out at 32 sites across England. Analysis of nearly 20,000 patients who completed treatment (at least two sessions) during this first year, showing 40% achieved reliable recovery post-treatment and 64% reliable improvement overall, while nearly 7% deteriorated. Recovery rates were highly variable, ranging from 24% to 57%, as were rates of reliable improvement (44–77%) and deterioration (2–11%).  Attendance of more treatment sessions, higher rates of stepping up from low- to high-intensity and having a greater proportion of experienced staff were all linked with better recovery rates.

Behav Res Ther 2013; 51: 597-606 

de Lusignan S et al. Referral to a new psychological therapy service is associated with reduced utilisation of healthcare and sickness absence by people with common mental health problems: a before and after comparison.

Study of linked primary, secondary and clinic data to look at healthcare use and sickness certification among people with common mental health problems (CMPHs), and then compare resource use between IAPT service users and non-users in the six months before and after IAPT referral at the two demonstration sites in Doncaster and Newham, East London.

Most (70%) people referred to IAPT had a CMHP but these represented a small proportion (6%) of the total population with a CMHP.

Overall people with CMHPs used more health services than those without over the study period, using more antidepressants (mean 5.25 more prescriptions) and having more inpatient episodes (0.29), occupied bed days (1.25), outpatient appointments (1.5) and A&E attendances (0.34). They also received nearly 10 times more sick notes.

People referred for IAPT used fewer resources than non-users in terms of: number of sick notes issued (0.11), and number of A&E attendances (0.04). They used more antidepressants (on average 0.15 more prescriptions) suggesting better adherence to medication.

J Epidemiol Community Health 2012; 66:e10

 

Clark DM et al. Improving access to psychological therapy: Initial evaluation of two UK demonstration sites.

Study of results after one year of IAPT at demonstration sites in Doncaster and Newham. Showed 3,102 out of a total of 4,451 patients referred to IAPT in Doncaster ‘concluded involvement’ with the service and 1,654 patients completed at least two sessions. Of 1,494 who completed and had pre- and post-treatment scores, 56% of patients recovered; 4% with data available moved from unemployment into part- or full-time employment.

Vast majority (97%) were seen by low-intensity therapist. Only 4% of the 650 people who were still cases after low-intensity therapy were stepped up to high-intensity intervention.

In Newham, 369 patients – out of a total of 1,043 referred – went through the system and 249 completed at least two sessions. Most (74%) patients received step 3 (high-intensity) CBT from a specialist therapist and the overall recovery rate was 55%, while there was a 10% net increase in people in work and not receiving sickness benefit.

Behav Res Ther 2009; 47: 910–920 

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