Symposium
Interventions and Care Delivery Models in the Context of Resource Limitations
Robert Smith, Ph.D.
Research Professor
Norwegian Institute of Public Health
Bergen, Hordaland, Norway
Marit Knapstad, Ph.D., Other
Research professor
Norwegian Institute of Public Health
Bergen, Hordaland, Norway
Background: Prompt Mental Health Care (PMHC) is Norway’s adaptation of the UK Improving Access to Psychological Therapies model, offering early, low-threshold cognitive behavioural therapy for adults with anxiety and mild-to-moderate depression. We summarize clinical, work-related, and economic outcomes from a pragmatic randomized controlled trial.
Methods: A total of 774 adults with symptoms of anxiety and/or depression were individually randomized (2:1) to PMHC (n = 527) or treatment as usual (n = 247) in two Norwegian municipalities. Self-reported symptom outcomes (PHQ-9, GAD-7) and recovery were assessed at six months. Trial data were linked to national registries to examine employment and welfare receipt, income, and publicly funded health-care use for up to five years, and to estimate cost–benefit and cost-utility (QALY) outcomes from both societal and public-sector perspectives.
Results: At 6 months, PMHC produced higher reliable recovery than TAU (58.5% vs 31.9%) and larger improvements in depression and anxiety (between-group effect sizes −0.88 and −0.60). Although short-term self-reported work participation did not differ, registry follow-up indicated higher odds of being in regular work without receiving welfare benefits in 2019–2022 (OR 1.27–1.43), with some evidence of reduced health-care spending. The estimated benefit–cost ratio was 5.26 and the probability that PMHC was cost-beneficial to the overall economy was 85.9%, while differences in public sector spending were small. Over three years, PMHC generated 0.24 additional QALYs at €1,551 incremental health-care costs (ICER €6,376/QALY), with a high probability of being cost-effective at conservative willingness-to-pay thresholds; including welfare transfers suggested the programme was close to cost-neutral or potentially cost-saving.
Conclusions: The PMHC program yields large and sustained improvements in symptoms and health-related quality of life, with favourable long-term economic returns. Results demonstrate that scalable psychological therapy can deliver substantial value for money within a public mental-health system.