Minimal-Contact Versus Standard Cognitive Behavioral Therapy for Irritable Bowel Syndrome: Cost-Effectiveness Results of a Multisite Trial

2021 ◽  
Author(s):  
Laura J Dunlap ◽  
James Jaccard ◽  
Jeffrey M Lackner
Keyword(s):  
Irritable Bowel Syndrome ◽  
Cost Effectiveness ◽  
Behavioral Therapy ◽  
Cost Effective ◽  
Symptom Improvement ◽  
Activity Based Costing ◽  
Patient Cost ◽  
Minimal Contact ◽  
Irritable Bowel ◽  
The Cost

Abstract Background Irritable bowel syndrome (IBS) is a common, often disabling gastrointestinal (GI) disorder for which there is no satisfactory medical treatment but is responsive to cognitive behavior therapy (CBT). Purpose To evaluate the costs and cost-effectiveness of a minimal contact version of CBT (MC-CBT) condition for N = 145 for IBS relative to a standard, clinic-based CBT (S-CBT; N = 146) and a nonspecific comparator emphasizing education/support (EDU; N = 145). Method We estimated the per-patient cost of each treatment condition using an activity-based costing approach that allowed us to identify and estimate costs for specific components of each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of MC-CBT relative to S-CBT and EDU. We then evaluated the cost-effectiveness of MC-CBT relative to these alternatives for selected outcomes at immediate posttreatment and 6 months posttreatment, using both an intent-to-treatment and per-protocol methodology. Key outcomes included scores on the Clinical Global Impressions-Improvement Scale and the percentage of patients who positively responded to treatment. Results The average per-patient cost of delivering MC-CBT was $348, which was significantly less than the cost of S-CBT ($644) and EDU ($457) (p < .01). Furthermore, MC-CBT produced better average patient outcomes at immediate and 6 months posttreatment relative to S-CBT and EDU (p < .01). The current findings indicated that MC-CBT is a cost-effective option relative to S-CBT and EDU. Conclusion As predicted, MC-CBT was delivered at a lower cost per patient than S-CBT and performed better over time on the primary outcome of global IBS symptom improvement.

The cost-effectiveness of psychotherapy and SSRI antidepressants for severe irritable bowel syndrome

2001 ◽  
Vol 120 (5) ◽  
pp. A115 ◽  
Author(s):  
Francis H. Creed ◽  
Lakshmi Fernandes ◽  
Elspeth Guthrie ◽  
Stephen Palmer ◽  
Joy Ratcliffe ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Cost Effectiveness ◽  
Irritable Bowel ◽  
The Cost

scholarly journals Cost-effectiveness of internet-delivered cognitive–behavioural therapy for adolescents with irritable bowel syndrome

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023881 ◽  
Author(s):  
Filipa Sampaio ◽  
Marianne Bonnert ◽  
Ola Olén ◽  
Erik Hedman ◽  
Maria Lalouni ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Irritable Bowel Syndrome ◽  
Cost Effectiveness ◽  
Resource Use ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
The Difference ◽  
Irritable Bowel

ObjectiveTo assess whether exposure-based internet-delivered cognitive–behavioural therapy (internet-CBT) is a cost-effective treatment for adolescents with irritable bowel syndrome (IBS) compared with a waitlist control, from a societal perspective, based on data from a randomised trial.DesignWithin-trial cost-effectiveness analysis.SettingParticipants were recruited from the whole of Sweden via primary, secondary and tertiary care clinics reached through news media and advertising.ParticipantsAdolescents (aged 13–17) with a diagnosis of IBS.InterventionsParticipants were randomised to either an exposure-based internet-CBT, including 10 weekly modules for adolescents and five modules for parents, or a waitlist.Outcome measuresThe main health outcome was the quality-adjusted life-year (QALY) estimated by mapping Pediatric Quality-of-Life Inventory (PedsQL) scores onto EQ-5D-3L utilities. The secondary outcome was the point improvement on the PedsQL scale. Data on health outcomes and resource use were collected at baseline and 10 weeks post-treatment. Resource use was measured using the Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry (TIC-P) . Incremental cost-effectiveness ratios (ICER) were calculated as the difference in average costs by the difference in average outcomes between groups.ResultsThe base-case results showed that internet-CBT costs were on average US$170.24 (95% CI 63.14 to 315.04) more per participant than the waitlist. Adolescents in the internet-CBT group showed small QALY gains (0.0031; 95% CI 0.0003 to 0.0061), and an average improvement of 5.647 points (95% CI 1.82 to 9.46) on the PedsQL compared with the waitlist. Internet-CBT yielded an ICER of $54 916/QALY gained and a probability of cost-effectiveness of 74% given the Swedish willingness-to-pay threshold. The ICER for the outcome PedsQL was US$85.29/point improvement.ConclusionsOffering internet-CBT to adolescents with IBS improves health-related quality of life and generates small QALY gains at a higher cost than a waitlist control. Internet-CBT is thus likely to be cost-effective given the strong efficacy evidence, small QALY gains and low cost.Trial registration numberNCT02306369; Results.

The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome

2003 ◽  
Vol 124 (2) ◽  
pp. 303-317 ◽  
Author(s):  
Francis Creed ◽  
Lakshmi Fernandes ◽  
Elspeth Guthrie ◽  
Stephen Palmer ◽  
Joy Ratcliffe ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Cost Effectiveness ◽  
Irritable Bowel ◽  
The Cost

scholarly journals Cognitive behavioral therapy for irritable bowel syndrome induces bidirectional alterations in the brain-gut-microbiome axis associated with gastrointestinal symptom improvement

Microbiome ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jonathan P. Jacobs ◽  
Arpana Gupta ◽  
Ravi R. Bhatt ◽  
Jacob Brawer ◽  
Kan Gao ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Functional Connectivity ◽  
Cognitive Behavioral Therapy ◽  
Gut Microbiome ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Symptom Improvement ◽  
Abdominal Symptoms ◽  
Irritable Bowel ◽  
The Brain

Abstract Background There is growing recognition that bidirectional signaling between the digestive tract and the brain contributes to irritable bowel syndrome (IBS). We recently showed in a large randomized controlled trial that cognitive behavioral therapy (CBT) reduces IBS symptom severity. This study investigated whether baseline brain and gut microbiome parameters predict CBT response and whether response is associated with changes in the brain-gut-microbiome (BGM) axis. Methods Eighty-four Rome III-diagnosed IBS patients receiving CBT were drawn from the Irritable Bowel Syndrome Outcome Study (IBSOS; ClinicalTrials.gov NCT00738920) for multimodal brain imaging and psychological assessments at baseline and after study completion. Fecal samples were collected at baseline and post-treatment from 34 CBT recipients for 16S rRNA gene sequencing, untargeted metabolomics, and measurement of short-chain fatty acids. Clinical measures, brain functional connectivity and microstructure, and microbiome features associated with CBT response were identified by multivariate linear and negative binomial models. Results At baseline, CBT responders had increased fecal serotonin levels, and increased Clostridiales and decreased Bacteroides compared to non-responders. A random forests classifier containing 11 microbial genera predicted CBT response with high accuracy (AUROC 0.96). Following treatment, CBT responders demonstrated reduced functional connectivity in regions of the sensorimotor, brainstem, salience, and default mode networks and changes in white matter in the basal ganglia and other structures. Brain changes correlated with microbiome shifts including Bacteroides expansion in responders. Conclusions Pre-treatment intestinal microbiota and serotonin levels were associated with CBT response, suggesting that peripheral signals from the microbiota can modulate central processes affected by CBT that generate abdominal symptoms in IBS. CBT response is characterized by co-correlated shifts in brain networks and gut microbiome that may reflect top-down effects of the brain on the microbiome during CBT.

scholarly journals Cost-effectiveness of guided internet-based cognitive behavioral therapy compared with usual care for depression: results from an implementation project (Preprint)

2021 ◽  
Author(s):  
Jordi Piera-Jiménez ◽  
Anne Etzelmueller ◽  
Spyros Kolovos ◽  
Frans Folkvord ◽  
Francisco Lupiáñez-Villanueva
Keyword(s):  
Cost Effectiveness ◽  
Cognitive Behavioral Therapy ◽  
Usual Care ◽  
Transition Probabilities ◽  
Behavioral Therapy ◽  
Scale Up ◽  
Cost Effective ◽  
Cognitive Behavioral ◽  
Sensitivity Analyses ◽  
The Cost

BACKGROUND Major depressive disorder (MDD) is a chronic condition whereby the prevalence is expected to grow with the aging trend of high-income countries. Internet-based cognitive-behavioral therapy (iCBT) has proven efficacy in treating MDD. OBJECTIVE The objective of this study was to assess the cost-effectiveness of implementing a community-based iCBT intervention (Super@, the Spanish program for the MasterMind project) for treating MDD. METHODS The cost-effectiveness of the Super@ program was assessed with the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing (MAFEIP) tool, using a 3-state Markov model. Data from the cost and effectiveness of the intervention were prospectively collected from the implementation of the program by a healthcare provider in Badalona (Spain); the corresponding data for usual care were gathered from the literature. The health states, transition probabilities, and utilities were computed using the scores of the patient health questionnaire 9 (PHQ-9). RESULTS The analysis was performed using data from 229 participants using the Super@ program. Results showed that the intervention was more costly than usual care; the 3%-discounted and non-discounted incremental cost-effectiveness ratios (ICERs) were € 29,367 and € 26,484 per quality-adjusted life-year (QALY), respectively. The intervention was cost-effective based on the 30K willingness-to-pay (WTP) threshold typically applied in Spain. According to the deterministic sensitivity analyses, the potential reduction of costs associated with intervention scale-up would reduce the ICER of the intervention, although it remained more costly than usual care. A discount in the incremental effects up to 5% exceeded the WTP threshold of 30K. CONCLUSIONS The Super@ program, an iCBT intervention for treating MDD, was more costly than TAU. Still, its implementation in Spain would be cost-effective from the healthcare and societal perspective at a WTP threshold of 30K compared with TAU. CLINICALTRIAL Not applicable

scholarly journals Cognitive behavioral treatment for irritable bowel syndrome: a recent literature review

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nagisa Sugaya ◽  
Kentaro Shirotsuki ◽  
Mutsuhiro Nakao
Keyword(s):  
Irritable Bowel Syndrome ◽  
Behavioral Treatment ◽  
Psychological Intervention ◽  
Behavioral Therapy ◽  
Cost Effective ◽  
Cognitive Behavioral ◽  
Cognitive Behavioral Treatment ◽  
Psychosomatic Disorder ◽  
Face To Face ◽  
Irritable Bowel

AbstractIrritable bowel syndrome (IBS) is a gastrointestinal psychosomatic disorder that often develops and worsens with stress. Hence, it is important to treat it from both, its physical and mental aspects. We reviewed recent research on cognitive-behavioral therapy (CBT)—one of the most widely studied psychological treatments for IBS—since it focuses on addressing the cognitions and behaviors associated with IBS symptoms, and combines diverse content, such as cognitive techniques, exposure, stress management, and mindfulness, whose effects have been widely studied. Research on CBT for IBS varies not only in terms of content of the interventions, but also in terms of implementation (individual or group, face-to-face or online). Internet-delivered CBT has recently shown the possibility of providing more accessible and cost-effective psychological intervention to IBS patients in formats, other than face-to-face. In recent years, many standardized scales that allow for IBS-specific psychological assessments have been used in clinical studies of CBT for IBS. Tools that competently deliver effective interventions and properly measure their effectiveness are expected to spread to many people suffering from IBS.

The cost-effectiveness of psychotherapy and SSRI antidepressants for severe irritable bowel syndrome

2001 ◽  
Vol 120 (5) ◽  
pp. A115-A115 ◽  
Author(s):  
F CREED ◽  
L FERNANDES ◽  
E GUTHRIE ◽  
S PALMER ◽  
J RATCLIFFE ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Cost Effectiveness ◽  
Irritable Bowel ◽  
The Cost
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