PSS13 Cost-Effectiveness of Specialized Treatment Based on Cognitive Behavioural Therapy Versus Usual Care for Tinnitus

BackgroundSleep problems are pervasive in people with schizophrenia, but there are no clinical guidelines for their treatment. The Better Sleep Trial (BEST) concluded that suitably adapted cognitive–behavioural therapy (CBT) is likely to be highly effective, although its cost-effectiveness is unknown.AimsTo assess the potential cost-effectiveness of CBT for sleep disorders in patients with schizophrenia.MethodAn economic evaluation of the BEST study with a 6-month time horizon was used to establish the cost-effectiveness of CBT plus usual care in terms of costs per quality-adjusted life year (QALY) gained. Uncertainty was displayed on cost-effectiveness planes and acceptability curves. Value of information analysis was performed to estimate the benefits of obtaining further evidence.ResultsOn average, the treatment led to a 0.035 QALY gain (95% CI −0.016 to 0.084), and £1524 (95% CI −10 529 to 4736) and £1227 (95% CI −10 395 to 5361) lower costs from National Health Service and societal perspectives, respectively. The estimated value of collecting more information about the effects of the CBT on costs and QALYs was approximately £87 million.ConclusionsCBT for insomnia in people with schizophrenia is effective and potentially cost-effective. A larger trial is needed to provide clear evidence about its cost-effectiveness.RelevancePatients with schizophrenia have multiple complex health needs, as well as very high rates of depression, suicidal ideation and poor physical health. The results of this study showed that treating pervasive sleep problems in this patient group with cognitive–behavioural therapy (CBT) is very likely to improve patient quality of life in the short term. Clinicians most commonly use hypnotic medication to treat sleeping disorders. This study indicates that CBT may be an effective and cost-effective intervention in this patient group. This alternative would also be aligned with patient preferences for psychological and behavioural-type therapy.Declaration of interestNone.

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Cost-effectiveness of therapist-delivered online cognitive–behavioural therapy for depression: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.073080 ◽

2010 ◽

Vol 197 (4) ◽

pp. 297-304 ◽

Cited By ~ 61

Author(s):

Sandra Hollinghurst ◽

Tim J. Peters ◽

Surinder Kaur ◽

Nicola Wiles ◽

Glyn Lewisand ◽

...

Keyword(s):

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Usual Care ◽

Cognitive Behavioural Therapy ◽

Controlled Trial ◽

Behavioural Therapy ◽

Qaly Gain ◽

Cognitive Behavioural ◽

Life Years ◽

Randomised Controlled

BackgroundTherapist-delivered online cognitive–behavioural therapy (CBT) has been found to be effective for depression in primary care.AimsTo determine the cost-effectiveness of online CBT compared with usual care.MethodEconomic evaluation at 8 months alongside a randomised controlled trial. Cost to the National Health Service (NHS), personal costs, and the value of lost productivity, each compared with outcomes based on the Beck Depression Inventory and quality-adjusted life-years (QALYs). Incremental analysis indicated the NHS cost per QALY gain.ResultsOnline CBT was more expensive than usual care, although the outcomes for the CBT group were better. Cost per QALY gain based on complete case data was £17 173, and £10 083 when missing data were imputed.ConclusionsOnline CBT delivered by a therapist in real time is likely to be cost-effective compared with usual care if society is willing to pay at least £20 000 per QALY; it could be a useful alternative to face-to-face CBT.

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Cost-effectiveness of cognitive behavioural therapy, graded exercise and usual care for patients with chronic fatigue in primary care

Psychological Medicine ◽

10.1017/s0033291704001928 ◽

2004 ◽

Vol 34 (6) ◽

pp. 991-999 ◽

Cited By ~ 28

Author(s):

P. McCRONE ◽

L. RIDSDALE ◽

L. DARBISHIRE ◽

P. SEED

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Usual Care ◽

Cognitive Behavioural Therapy ◽

Chronic Fatigue ◽

Behavioural Therapy ◽

Self Help ◽

Cognitive Behavioural ◽

Graded Exercise ◽

The Cost

Background. Chronic fatigue is a common condition, frequently presenting in primary care. The aim of this study was to compare the cost-effectiveness of cognitive behavioural therapy (CBT) and graded exercise therapy (GET), and to compare therapy with usual care plus a self-help booklet (BUC).Method. Patients drawn from general practices in South East England were randomized to CBT or GET. The therapy groups were then compared to a group receiving BUC recruited after the randomized phase. The main outcome measure was clinically significant improvements in fatigue. Cost-effectiveness was assessed using the net-benefit approach and cost-effectiveness acceptability curves.Results. Costs were available for 132 patients, and cost-effectiveness results for 130. Costs were dominated by informal care. There were no significant outcome or cost differences between the therapy groups. The combined therapy group had significantly better outcomes than the standard care group, and costs that were on average £149 higher (a non-significant difference). Therapy would have an 81·9% chance of being cost-effective if society were willing to attach a value of around £500 to each four-point improvement in fatigue.Conclusion. The cost-effectiveness of cognitive behavioural therapy and graded exercise were similar unless higher values were placed on outcomes, in which case CBT showed improved cost-effectiveness. The cost of providing therapy is higher than usual GP care plus a self-help booklet, but the outcome is better. The strength of this evidence is limited by the use of a non-randomized comparison. The cost-effectiveness of therapy depends on how much society values reductions in fatigue.

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Computerised cognitive–behavioural therapy for depression in adolescents: 12-month outcomes of a UK randomised controlled trial pilot study

BJPsych Open ◽

10.1192/bjo.2019.91 ◽

2019 ◽

Vol 6 (1) ◽

Author(s):

Barry Wright ◽

Lucy Tindall ◽

Rebecca Hargate ◽

Victoria Allgar ◽

Dominic Trépel ◽

...

Keyword(s):

Mental Health ◽

Cost Effectiveness ◽

Pilot Study ◽

Cognitive Behavioural Therapy ◽

Care Pathway ◽

Intervention Group ◽

Behavioural Therapy ◽

Self Help ◽

Cognitive Behavioural ◽

Randomised Controlled

Background Computerised cognitive–behavioural therapy (CCBT) in the care pathway has the potential to improve access to psychological therapies and reduce waiting lists within Child and Adolescent Mental Health Services, however, more randomised controlled trials (RCTs) are needed to assess this. Aims This single-centre RCT pilot study compared a CCBT program (Stressbusters) with an attention control (self-help websites) for adolescent depression at referral to evaluate the clinical and cost-effectiveness of CCBT (trial registration: ISRCTN31219579). Method The trial ran within community and clinical settings. Adolescents (aged 12–18) presenting to their primary mental health worker service for low mood/depression support were assessed for eligibility at their initial appointment, 139 met inclusion criteria (a 33-item Mood and Feelings Questionnaire score of ≥20) and were randomised to Stressbusters (n = 70) or self-help websites (n = 69) using remote computerised single allocation. Participants completed mood, quality of life (QoL) and resource-use measures at intervention completion, and 4 and 12 months post-intervention. Changes in self-reported measures and completion rates were assessed by group. Results There was no significant difference between CCBT and the website group at 12 months. Both showed improvements on all measures. QoL measures in the intervention group showed earlier improvement compared with the website group. Costs were lower in the intervention group but the difference was not statistically significant. The cost-effectiveness analysis found just over a 65% chance of Stressbusters being cost-effective compared with websites. The 4-month follow-up results from the initial feasibility study are reported separately. Conclusions CCBT and self-help websites may both have a place in the care pathway for adolescents with depression.

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A Tailored, Therapist-Guided Internet-Based Cognitive Behavioral Intervention as an Addition to Care as Usual for Patients With Rheumatoid Arthritis: Economic Evaluation alongside an RCT (Preprint)

10.2196/preprints.9997 ◽

2018 ◽

Author(s):

Maaike Ferwerda ◽

Sylvia van Beugen ◽

Henriët van Middendorp ◽

Henk Visser ◽

Harald Vonkeman ◽

...

Keyword(s):

Quality Of Life ◽

Rheumatoid Arthritis ◽

Usual Care ◽

Cognitive Behavioural Therapy ◽

Behavioural Therapy ◽

Healthcare Use ◽

Cognitive Behavioural ◽

Related Quality ◽

Health Related

BACKGROUND A chronic somatic condition, such as rheumatoid arthritis (RA), can significantly reduce health related quality of life due to psychological, social and physical consequences. Cognitive behavioural therapy can aid in improving outcomes for patients, for example in terms of disease trajectory, health care utilization, and workplace disability of patients. In recent years internet-based cognitive behavioural therapy has been proposed as an effective and efficient way to offer cognitive behavioural therapy and further implementation. However, little research has been conducted to support this proposition. OBJECTIVE To stimulate the implementation of effective treatment strategies for improving health-related quality of life (HRQoL) of patients with rheumatoid arthritis (RA), cost-benefit ratios are required to inform stake-holders. A cost-effectiveness study from a societal perspective was conducted alongside a randomized controlled trial on a tailored and therapist-guided internet-based cognitive behavioural intervention (ICBT) for patients with elevated levels of distress, as an addition to usual care alone. METHODS Data were collected at baseline/pre-intervention, 6 months/post-intervention, and three-monthly thereafter during one year follow-up. Effects were measured in quality-adjusted life years (QALYs) and costs from a societal perspective including healthcare sector costs (including healthcare use, medication, and intervention costs), patient travel costs for healthcare use, and costs associated with loss of labor. RESULTS The intervention improved quality of life compared to usual care alone (Δ QALYs= 0.059), but also led to higher costs (Δ= € 4.211,44), which reduced substantially when medication costs were left out of the equation (Δ= € 1.862,72). Most (93%) of the simulated ICERS were in the north-east quadrant, suggesting a high probability that the intervention is effective in improving HRQoL, but at a greater monetary cost for society compared to usual care alone. CONCLUSIONS A tailored and guided ICBT intervention as an addition to usual care for patients with RA with heightened distress was effective in gaining quality of life. Consequently, implementation of the ICBT into standard healthcare for patients with RA is recommended, yet further study into cost reductions in this population is warranted. CLINICALTRIAL National trial registry number:NTR2100

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Cost-effectiveness and cost-utility evaluation of the individual vs. group transdiagnostic psychological treatment for emotional disorders in Primary Care (PsicAP-Costs) v2

10.17504/protocols.io.bx2npqde ◽

2021 ◽

Author(s):

Angel Aguilera-Martin ◽

Mario Gálvez-Lara ◽

Fátima Cuadrado ◽

Eliana Moreno ◽

Francisco García-Torres ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Emotional Disorders ◽

Cognitive Behavioural Therapy ◽

Psychological Treatment ◽

Behavioural Therapy ◽

Cost Utility ◽

Cognitive Behavioural ◽

Utility Evaluation ◽

The Individual

The aim of this study is to compare, in cost-effectiveness and cost-utility terms, a brief transdiagnostic cognitive-behavioural therapy in two different modes, individual and group, with the treatment usually administered in primary care (TAU). Participants between 18 and 65 years old and with, according to the pretreatment evaluation, mild to moderate emotional disorders will be randomly allocated to the three clusters. They will be assessed again immediately after treatment and 6 and 12 months later. ClinicalTrials.gov: NCT04847310

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PCN77 COST-UTILITY, COST-EFFECTIVENESS, AND BUDGET IMPACT OF INTERNET-BASED COGNITIVE BEHAVIOURAL THERAPY FOR BREAST CANCER SURVIVORS WITH TREATMENT-INDUCED MENOPAUSAL SYMPTOMS

Value in Health ◽

10.1016/j.jval.2019.09.274 ◽

2019 ◽

Vol 22 ◽

pp. S450

Author(s):

J.G.E. Verbeek ◽

V. Atema ◽

J.C. Mewes ◽

M. van Leeuwen ◽

H.S.A. Oldenburg ◽

...

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Cancer Survivors ◽

Cognitive Behavioural Therapy ◽

Breast Cancer Survivors ◽

Budget Impact ◽

Behavioural Therapy ◽

Cost Utility ◽

Cognitive Behavioural ◽

Utility Cost

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Cognitive behavioural therapy significantly reduces anxiety in patients with implanted cardioverter defibrillator compared with usual care: Findings from the Screen-ICD randomised controlled trial

European Journal of Preventive Cardiology ◽

10.1177/2047487319874147 ◽

2019 ◽

Vol 27 (3) ◽

pp. 258-268 ◽

Cited By ~ 4

Author(s):

Selina K Berg ◽

Trine B Rasmussen ◽

Margrethe Herning ◽

Jesper H Svendsen ◽

Anne V Christensen ◽

...

Keyword(s):

Usual Care ◽

Cognitive Behavioural Therapy ◽

Primary Outcome ◽

Depression Scale ◽

Behavioural Therapy ◽

Anxiety And Depression ◽

Hospital Anxiety ◽

Cardioverter Defibrillator ◽

Cognitive Behavioural ◽

Secondary Outcomes

Aim The aim of this study was to investigate the effect of a cognitive behavioural therapy intervention provided by trained cardiac nurses plus usual care compared with usual care alone in patients with an implanted cardioverter defibrillator who, prior to randomization, had presented with symptoms of anxiety measured by the Hospital Anxiety and Depression Scale. Background Around 20–25% of all patients with an implanted cardioverter defibrillator experience anxiety. Among these patients anxiety is associated with mortality, presumably explained by risk behaviour and activation of the autonomic nervous system. We hypothesised that cognitive behavioural therapy provided by cardiac nurses in an out-patient setting would be an effective treatment of anxiety. Methods This was an investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive behavioural therapy plus usual care or to usual care. The primary outcome was Hospital Anxiety and Depression Scale-Anxiety mean score at 16 weeks. Secondary outcomes included Hospital Anxiety and Depression Scale-Depression, Becks Anxiety Inventory, HeartQoL and Hamilton Anxiety Scale. Primary outcome analysis was based on the intention-to-treat principle. Results A total of 88 participants were included, 66% men, mean age 64.3 years and 61% had primary indication implantable cardioverter defibrillator. A significant difference after 16 weeks was found between groups: intervention group (Hospital Anxiety and Depression Scale-A mean (standard deviation) 4.95 points (3.30) versus usual care group 8.98 points (4.03) ( p < 0.0001)). Cohen's d was –0.86, indicating a strong clinical effect. The effect was supported by secondary outcomes. Conclusion Cognitive behavioural therapy provided by cardiac nurses to patients with a positive screening for anxiety had a statistically and clinically significant effect on anxiety compared with patients not receiving cognitive behavioural therapy.

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Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive–behavioural therapy in adolescents with major depression

The British Journal of Psychiatry ◽

10.1192/bjp.bp.107.038984 ◽

2007 ◽

Vol 191 (6) ◽

pp. 521-527 ◽

Cited By ~ 53

Author(s):

Sarah Byford ◽

Barbara Barrett ◽

Chris Roberts ◽

Paul Wilkinson ◽

Bernadka Dubicka ◽

...

Keyword(s):

Cost Effectiveness ◽

Major Depression ◽

Cognitive Behavioural Therapy ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Clinical Care ◽

Cost Effective ◽

Behavioural Therapy ◽

Short Term ◽

Cognitive Behavioural

BackgroundMajor depression is an important and costly problem among adolescents, yet evidence to support the provision of cost-effective treatments is lacking.AimsTo assess the short-term cost-effectiveness of combined selective serotonin reuptake inhibitors (SSRIs) and cognitive–behavioural therapy (CBT) together with clinical care compared with SSRIs and clinical care alone in adolescents with major depression.MethodPragmatic randomised controlled trial in the UK. Outcomes and costs were assessed at baseline, 12 and 28 weeks.ResultsThe trial comprised 208 adolescents, aged 11–17 years, with major or probable major depression who had not responded to a brief initial psychosocial intervention. There were no significant differences in outcome between the groups with and without CBT. Costs were higher in the group with CBT, although not significantly so (P=0.057). Cost-effectiveness analysis and exploration of the associated uncertainty suggest there is less than a 30% probability that CBT plus SSRIs is more cost-effective than SSRIs alone.ConclusionsA combination of CBT plus SSRIs is not more cost-effective in the short-term than SSRIs alone for treating adolescents with major depression in receipt of routine specialist clinical care.

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