Outcomes and Cost-Effectiveness of an Interdisciplinary Clinic for Functional Neurologic Disorders.

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.