Neurology. Clinical practice · 2026
Outcomes and Cost-Effectiveness of an Interdisciplinary Clinic for Functional Neurologic Disorders.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Anne Sravan, Lennon Matthew J, Swift Emily, Jervis Noni, Harris Whitney, Gow Kate, Walpola Ishan C, Connors Michael, Moss Rebecca, Crawford John D, Sachdev Perminder S, Mohan Adith
Аннотация
BACKGROUND AND OBJECTIVES: Functional neurologic disorder (FND) is a common and disabling condition associated with diagnostic delays, poor outcomes, and fragmented care. Evidence for interdisciplinary models within public health systems is limited. We evaluated outcomes and cost-effectiveness of an interdisciplinary FND clinic in a public hospital.
METHODS: We conducted a prospective observational cohort study of 101 individuals referred to a public interdisciplinary FND clinic in Sydney, Australia. All patients received neuropsychiatric assessment and multidisciplinary team discussion involving psychology, physiotherapy, and occupational therapy to guide ongoing care. Forty-two patients in addition completed a 6-week structured psycho-behavioral group program. Outcomes were assessed at intake, 1-week, 3-month, and 6-month follow-up using measures of functioning (World Health Organization Disability Assessment Scale total score 2.0), quality of life (EQ-5D-5L, SF-36), psychological distress (K10), somatic symptom burden Patient Health Questionnaire-15 (PHQ-15), and clinical severity (CGI-S/I, HoNOS). Mixed-effects models were used to assess repeated longitudinal change. Cost-effectiveness was evaluated using EQ-5D utilities and incremental cost-effectiveness ratios (ICERs).
RESULTS: Across the full cohort, CGI-S improved by -1.02 points at 6 months (95% CI -1.28 to -0.77; d = 0.95). In adjusted observational analyses, between-group differences were examined across clinical, functional, and economic outcomes. Compared with standard care, the intervention group showed greater CGI-S improvement at 3 months (B = -0.81, 95% CI -1.19 to -0.43; d = 0.92) and 6 months (B = -0.88, 95% CI -1.35 to -0.41; d = 0.99). SF-36 social functioning scores improved at 6 months (+17.1, 95% CI + 6.2 to +28.1; d = 0.68). PHQ-15 scores decreased (-2.1, 95% CI -4.1 to -0.1). The intervention generated an estimated +0.16 quality-adjusted life year (QALYs) over 12 months (95% CI 0.08 to 0.23), corresponding to an ICER of AU$9,093 per QALY (95% CI $6,077.88 to $18,332.89).
DISCUSSION: Participation in an interdisciplinary FND clinic with an embedded brief psycho-behavioral program was associated with clinically meaningful improvements and favorable cost-effectiveness estimates. Findings support consideration of interdisciplinary, psychologically informed FND services within public health systems.
METHODS: We conducted a prospective observational cohort study of 101 individuals referred to a public interdisciplinary FND clinic in Sydney, Australia. All patients received neuropsychiatric assessment and multidisciplinary team discussion involving psychology, physiotherapy, and occupational therapy to guide ongoing care. Forty-two patients in addition completed a 6-week structured psycho-behavioral group program. Outcomes were assessed at intake, 1-week, 3-month, and 6-month follow-up using measures of functioning (World Health Organization Disability Assessment Scale total score 2.0), quality of life (EQ-5D-5L, SF-36), psychological distress (K10), somatic symptom burden Patient Health Questionnaire-15 (PHQ-15), and clinical severity (CGI-S/I, HoNOS). Mixed-effects models were used to assess repeated longitudinal change. Cost-effectiveness was evaluated using EQ-5D utilities and incremental cost-effectiveness ratios (ICERs).
RESULTS: Across the full cohort, CGI-S improved by -1.02 points at 6 months (95% CI -1.28 to -0.77; d = 0.95). In adjusted observational analyses, between-group differences were examined across clinical, functional, and economic outcomes. Compared with standard care, the intervention group showed greater CGI-S improvement at 3 months (B = -0.81, 95% CI -1.19 to -0.43; d = 0.92) and 6 months (B = -0.88, 95% CI -1.35 to -0.41; d = 0.99). SF-36 social functioning scores improved at 6 months (+17.1, 95% CI + 6.2 to +28.1; d = 0.68). PHQ-15 scores decreased (-2.1, 95% CI -4.1 to -0.1). The intervention generated an estimated +0.16 quality-adjusted life year (QALYs) over 12 months (95% CI 0.08 to 0.23), corresponding to an ICER of AU$9,093 per QALY (95% CI $6,077.88 to $18,332.89).
DISCUSSION: Participation in an interdisciplinary FND clinic with an embedded brief psycho-behavioral program was associated with clinically meaningful improvements and favorable cost-effectiveness estimates. Findings support consideration of interdisciplinary, psychologically informed FND services within public health systems.