Cost-effectiveness of digital cognitive behavioral therapy (Sleepio) for insomnia: a Markov simulation model in the United States

SLEEP ◽  
2020 ◽  
Author(s):  
Michael Darden ◽  
Colin A Espie ◽  
Jenna R Carl ◽  
Alasdair L Henry ◽  
Jennifer C Kanady ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cost Effective ◽  
The United States ◽  
Cognitive Behavioral ◽  
Life Years ◽  
Insomnia Treatment ◽  
Group Cbt

Abstract Study Objectives To examine the cost-effectiveness and potential net monetary benefit (NMB) of a fully automated digital cognitive behavioral therapy (CBT) intervention for insomnia compared with no insomnia treatment in the United States (US). Similar relative comparisons were made for pharmacotherapy and clinician-delivered CBT (individual and group). Methods We simulated a Markov model of 100,000 individuals using parameters calibrated from the literature including direct (treatment) and indirect costs (e.g. insomnia-related healthcare expenditure and lost workplace productivity). Health utility estimates were converted into quality-adjusted life years (QALYs) and one QALY was worth $50,000. Simulated individuals were randomized equally to one of five arms (digital CBT, pharmacotherapy, individual CBT, group CBT, or no insomnia treatment). Sensitivity was assessed by bootstrapping the calibrated parameters. Cost estimates were expressed in 2019 US dollars. Results Digital CBT was cost beneficial when compared with no insomnia treatment and had a positive NMB of $681.06 (per individual over 6 months). Bootstrap sensitivity analysis demonstrated that the NMB was positive in 94.7% of simulations. Relative to other insomnia treatments, digital CBT was the most cost-effective treatment because it generated the smallest incremental cost-effectiveness ratio (−$3,124.73). Conclusions Digital CBT was the most cost-effective insomnia treatment followed by group CBT, pharmacotherapy, and individual CBT. It is financially prudent and beneficial from a societal perspective to utilize automated digital CBT to treat insomnia at a population scale.

scholarly journals Features, Functionality, and Acceptability of Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States

2020 ◽  
Vol 29 (3) ◽  
pp. 476-490
Author(s):  
Vinaya Manchaiah ◽  
George Vlaescu ◽  
Srinivas Varadaraj ◽  
Elizabeth Parks Aronson ◽  
Marc A. Fagelson ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Cognitive Behavioral Therapy ◽  
Health Care Professionals ◽  
Behavioral Therapy ◽  
The United States ◽  
Cognitive Behavioral ◽  
Software Safety ◽  
Regulatory Aspects ◽  
The United Kingdom

Objective Although tinnitus is one of the most commonly reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related to accessibility of care and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence-based interventions are necessary. Internet-based cognitive behavioral therapy (ICBT) demonstrates potential as a means of delivering this support but is not currently available in the United States. This article discusses the adaptation of an ICBT intervention, originally used in Sweden, Germany, and the United Kingdom, for delivery in the United States. The aim of this study was to (a) modify the web platform's features to suit a U.S. population, (b) adapt its functionality to comply with regulatory aspects, and (c) evaluate the credibility and acceptability of the ICBT intervention from the perspective of health care professionals and patients with bothersome tinnitus. Materials/Method Initially, the iTerapi ePlatform developed in Sweden was adopted for use in the United States. Functional adaptations followed to ensure that the platform's functional and security features complied with both institutional and governmental regulations and that it was suitable for a U.S. population. Following these adaptations, credibility and acceptance of the materials were evaluated by both health care professionals ( n = 11) and patients with bothersome tinnitus ( n = 8). Results Software safety and compliance regulatory assessments were met. Health care professionals and patients reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability, and exercises provided in the ICBT platform. Modifications to the features and functionality of the platform were made according to user feedback. Conclusions Ensuring that the ePlatform employed the appropriate features and functionalities for the intended population was essential to developing the Internet-based interventions. The favorable user evaluations indicated that the intervention materials were appropriate for the tinnitus population in the United States.

scholarly journals Cost-Effectiveness of Olaratumab in Combination with Doxorubicin for Patients with Soft Tissue Sarcoma in the United States

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Santiago Zuluaga-Sanchez ◽  
Lisa M. Hess ◽  
Sorrel E. Wolowacz ◽  
Yulia D’yachkova ◽  
Emma Hawe ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Meta Analysis ◽  
Single Agent ◽  
Cost Effective ◽  
Standard Of Care ◽  
The United States ◽  
Life Years

Background. Standard first-line treatments for advanced soft tissue sarcoma (STS) have changed little for 40 years, and outcomes have been poor. Recently, the United States (US) Food and Drug Administration conditionally approved olaratumab in combination with doxorubicin (Olara + Dox) based on a randomized phase II trial that reported a significant 11.8-month improvement in median survival versus single-agent doxorubicin (Dox). The present study investigated the cost-effectiveness of Olara + Dox compared with Dox and five other standard-of-care regimens from the US payer perspective. Methods. An economic model was constructed to estimate costs and outcomes over patients’ lifetimes from start of therapy. Progression-free and overall survival were based on survival analysis of patient-level data and a meta-analysis. Adverse-event rates were based on trials. Costs were from published sources. Results. Olara + Dox resulted in an estimated additional 1.27 life-years (LYs) compared with Dox, with an increase in total expected lifetime costs of $133,653. The incremental cost-effectiveness ratio (ICER) was estimated at $105,408 per LY gained; in a fully incremental analysis, all other regimens were dominated (higher costs and lower LYs or a higher ICER). Conclusion. Olara + Dox is cost-effective for STS treatment compared with Dox and other standard-of-care regimens at willingness-to-pay thresholds of $150,000 per LY and above.

scholarly journals Is bouldering-psychotherapy a cost-effective way to treat depression when compared to group cognitive behavioral therapy – results from a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Larissa Schwarzkopf ◽  
Lisa Dorscht ◽  
Ludwig Kraus ◽  
Katharina Luttenberger
Keyword(s):  
Cost Effectiveness ◽  
Cognitive Behavioral Therapy ◽  
Rating Scale ◽  
Behavioral Therapy ◽  
Productivity Loss ◽  
Cost Effective ◽  
Routine Care ◽  
Cognitive Behavioral ◽  
Distributed Model ◽  
Depression Symptoms

Abstract Background Bouldering-Psychotherapy (BPT) has proven to effectively reduce depressive symptoms, but evidence on its cost-effectiveness is lacking. Corresponding information is paramount to support health policy decision making on a potential implementation of BPT in routine care. Methods Using data from the German KuS trial BPT was compared with group Cognitive Behavioral Therapy (CBT). Severity of depression symptoms at end of the intervention was operationalized via Montgomery-Asberg Depression Rating Scale (MADRS) and Patient Health Questionnaire (PHQ-9). Adopting a societal perspective, direct medical costs and productivity loss were calculated based on standardized unit costs. To determine incremental cost-effectiveness ratios (ICER) and cost-effectiveness-acceptance curves (CEAC), adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) were obtained from 1000 simultaneous bootstrap replications. Results BPT was related to improved effects (AMDs: MADRS -2.58; PHQ-9: − 1.35) at higher costs (AMD: +€ 754). No AMD was significant. ICERs amounted to €288 per MADRS-point and €550 per PHQ-9-point. For both effect parameters about 20% of bootstrap replications indicated dominance of BPT, and about 75% larger effects at higher costs. At hypothetical willingness to pay (WTP) thresholds of €241 (MADRS) and €615 (PHQ-9) per unit of change BPT had a 50% probability of being cost-effective. Conclusion BPT is a promising alternate treatment strategy which – in absence of established WTP thresholds for improving symptoms of depression – cannot unambiguously be claimed cost-effective. Further studies defining subgroups that particularly benefit from BPT appear paramount to delineate recommendations for an efficient prospective roll-out to routine care.

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 therapy for psychosis – training practices and dissemination in the United States

Psychosis ◽  
2013 ◽  
Vol 5 (3) ◽  
pp. 296-305 ◽  
Author(s):  
D. Kimhy ◽  
N. Tarrier ◽  
S. Essock ◽  
D. Malaspina ◽  
D. Cabannis ◽  
...  
Keyword(s):  
United States ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
The United States ◽  
Cognitive Behavioral

scholarly journals Cost-Effectiveness of Short-Course Radiation Plus Temozolomide for the Treatment of Newly Diagnosed Glioblastoma Among Elderly Patients in China and the United States

2021 ◽  
Vol 12 ◽  
Author(s):  
Jigang Chen ◽  
Xin Tong ◽  
Mingyang Han ◽  
Songfeng Zhao ◽  
Linjin Ji ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Elderly People ◽  
Cost Effective ◽  
The United States ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Newly Diagnosed ◽  
Life Years ◽  
The Us

Background: Glioblastoma multiforme (GBM) is a fatal type of brain tumor with a high incidence among elderly people. Temozolomide (TMZ) has proven to be an effective chemotherapeutic agent with significant survival benefits. This study aimed to evaluate the economic outcomes of radiotherapy (RT) and TMZ for the treatment of newly diagnosed GBM in elderly people in the United States (US) and China.Methods: A partitioned survival model was constructed for RT plus TMZ and RT alone among patients with methylated and unmethylated tumor status. Base case calculations and one-way and probabilistic sensitivity analyses were performed. Life-years, quality-adjusted life-years (QALYs), costs (in 2021 US dollars [$] and Chinese Yuan Renminbi [¥]), and incremental cost-effectiveness ratios (ICERs) were calculated.Results: RT plus TMZ was found to be associated with significantly higher costs and QALYs in all groups. Only US patients with methylated status receiving RT plus TMZ had an ICER ($89358.51) less than the willingness-to-pay (WTP) threshold of $100000 per QALY gained when compared with receiving RT alone. When the WTP threshold ranged from $100000 to $150000 from the US perspective, the probability of RT plus TMZ being cost-effective increased from 80.5 to 99.8%. The cost of TMZ must be lower than ¥120 per 20 mg for RT plus TMZ to be cost-effective among patients with methylated tumor status in China.Conclusion: RT plus TMZ was not cost-effective in China, and a reduction in the TMZ price was justified. However, it is highly likely to be cost-effective for patients with methylated tumor status in the US.

scholarly journals Cost-effectiveness and health impact of lung cancer screening with low-dose computed tomography for never smokers in Japan and the United States: a modelling study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Akiko Kowada
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Cost Effectiveness ◽  
Lung Cancer Screening ◽  
Cost Effective ◽  
The United States ◽  
Sensitivity Analyses ◽  
Life Years ◽  
Never Smokers ◽  
Low Dose Computed Tomography

Abstract Background Never smokers in Asia have a higher incidence of lung cancer than in Europe and North America. We aimed to assess the cost-effectiveness of lung cancer screening with low-dose computed tomography (LDCT) for never smokers in Japan and the United States. Methods We developed a state-transition model for three strategies: LDCT, chest X-ray (CXR), and no screening, using a healthcare payer perspective over a lifetime horizon. Sensitivity analyses were also performed. Main outcomes were costs, quality-adjusted life-years (QALYs), life expectancy life-years (LYs), incremental cost-effectiveness ratios (ICERs), and deaths from lung cancer. The willingness-to-pay level was US$100,000 per QALY gained. Results LDCT yielded the greatest benefits with the lowest cost in Japan, but the ICERs of LDCT compared with CXR were US$3,001,304 per QALY gained for American men and US$2,097,969 per QALY gained for American women. Cost-effectiveness was sensitive to the incidence of lung cancer. Probabilistic sensitivity analyses demonstrated that LDCT was cost-effective 99.3–99.7% for Japanese, no screening was cost-effective 77.7% for American men, and CXR was cost-effective 93.2% for American women. Compared with CXR, LDCT has the cumulative lifetime potential for 60-year-old Japanese to save US$117 billion, increase 2,339,349 QALYs and 3,020,102 LYs, and reduce 224,749 deaths, and the potential for 60-year-old Americans to cost US$120 billion, increase 48,651 QALYs and 67,988 LYs, and reduce 2,309 deaths. Conclusions This modelling study suggests that LDCT screening for never smokers has the greatest benefits and cost savings in Japan, but is not cost-effective in the United States. Assessing the risk of lung cancer in never smokers is important for introducing population-based LDCT screening.

scholarly journals Audiologist-Supported Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States: A Pilot Trial

2021 ◽  
pp. 1-13
Author(s):  
Eldré W. Beukes ◽  
Gerhard Andersson ◽  
Marc Fagelson ◽  
Vinaya Manchaiah
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Pilot Study ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
The United States ◽  
Cognitive Behavioral ◽  
Recruitment Strategy ◽  
Medium Effect

Background Patients often report that living with a condition such as tinnitus can be debilitating, worrying, and frustrating. Efficient ways to foster management strategies for individuals with tinnitus and promoting tinnitus self-efficacy are needed. Internet-based cognitive behavioral therapy (ICBT) for tinnitus shows promise as an evidence-based intervention in Europe, but is not available in the United States. The aim of this pilot study was to evaluate the feasibility of an ICBT intervention for tinnitus in the United States. Method This study reports the Phase 1 trial intended to support implementation of a larger randomized clinical trial (RCT) comparing ICBT to a weekly monitoring group. As a pilot study, a single-group pretest–posttest design was used to determine outcome potential, recruitment strategy, retention, and adherence rates of ICBT for tinnitus. The primary outcome was a change in tinnitus distress. Secondary outcome measures included measures of anxiety, depression, insomnia, tinnitus cognitions, hearing-related difficulties, and quality of life. Results Of the 42 screened participants, nine did not meet the inclusion criteria and six withdrew. There were 27 participants who completed the intervention, with a mean age of 55.48 (± 9.9) years. Feasibility was established, as a large pretest–posttest effect size of d  = 1.6 was found for tinnitus severity. Large pretest–posttest effect sizes were also found for tinnitus cognitions and hearing-related effects, and a medium effect was found for insomnia and quality of life. Treatment adherence varied with a retention rate of 85% ( n  = 23) at post-intervention assessment and 67% ( n  = 18) for the follow-up assessment. Conclusions This pilot study supported the feasibility of ICBT for tinnitus in the United States. Ways of improving intervention retention and recruitment rates need to be explored in future ICBT studies. Protocol refinements that were identified will be implemented prior to further RCTs to investigate the efficacy of ICBT for tinnitus in the United States. Supplemental Material https://doi.org/10.23641/asha.15501135

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