Feng, Y. (55583035000)Y. (55583035000)FengRoukas, C. (57204184920)C. (57204184920)RoukasRusso, M. (35764063200)M. (35764063200)RussoRepišti, S. (57222097413)S. (57222097413)RepištiKulenović, A. Džubur (57200311531)A. Džubur (57200311531)KulenovićStevović, L. Injac (37079647600)L. Injac (37079647600)StevovićKonjufca, J. (57226804826)J. (57226804826)KonjufcaMarkovska-Simoska, S. (57211128454)S. (57211128454)Markovska-SimoskaNovotni, L. (57271525100)L. (57271525100)NovotniRistić, I. (57191339222)I. (57191339222)RistićSmajić-Mešević, E. (57899675100)E. (57899675100)Smajić-MeševićUka, F. (56568223700)F. (56568223700)UkaZebić, M. (16508355400)M. (16508355400)ZebićVončina, L. (12792767600)L. (12792767600)VončinaBobinac, A. (32367455300)A. (32367455300)BobinacJovanović, N. (22956210600)N. (22956210600)Jovanović2025-06-122025-06-122022https://doi.org/10.1192/j.eurpsy.2022.2310https://www.scopus.com/inward/record.uri?eid=2-s2.0-85138494209&doi=10.1192%2fj.eurpsy.2022.2310&partnerID=40&md5=ea7561460a423e8c234d223c3a45da09https://remedy.med.bg.ac.rs/handle/123456789/3846Background. DIALOGþ is a digital psychosocial intervention aimed at making routine meetings between patients and clinicians therapeutically effective. This study aimed to evaluate the cost-effectiveness of implementing DIALOGþ treatment for patients with psychotic disorders in five low- and middle-income countries in Southeast Europe alongside a cluster randomised trial. Methods. Resource use and quality of life data were collected alongside the multi-country cluster randomised trial of 468 participants with psychotic disorders. Due to COVID-19 interruptions of the trial’s original 12-month intervention period, adjusted costs and quality-adjusted life years (QALYs) were estimated at the participant level using a mixed-effects model over the first 6 months only. We estimated the incremental cost-effectiveness ratio (ICER) with uncertainty presented using a cost-effectiveness plane and a cost-effectiveness acceptability curve. Seven sensitivity analyses were conducted to check the robustness of the findings. Results. The average cost of delivering DIALOGþ was €91.11 per participant. DIALOGþ was associated with an incremental health gain of 0.0032 QALYs (95% CI –0.0015, 0.0079), incremental costs of €84.17 (95% CI –8.18, 176.52), and an estimated ICER of €26,347.61. The probability of DIALOGþ being cost-effective against three times the weighted gross domestic product (GDP) per capita for the five participating countries was 18.9%. Conclusion. Evidence from the cost-effectiveness analyses in this study suggested that DIALOGþ involved relatively low costs. However, it is not likely to be cost-effective in the five participating countries compared with standard care against a willingness-to-pay threshold of three times the weighted GDP per capita per QALY gained. © The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association.Cluster randomised trialCost-effectivenessDIALOGþLow- and middle-income countries in Southeast EuropePsychotic disorders