A randomized controlled evaluation of the cost effectiveness of cognitive-behavioural guided self-care versus family therapy for adolescent bulimia nervosa in a catchment area-based population

BackgroundCognitive–behavioural self-care is advocated as a first step in the treatment of bulimia nervosa.AimsTo examine the effectiveness of a CD–ROM-based cognitive–behavioural intervention in bulimia nervosa and eating disorder not otherwise specified (NOS) (bulimic type) in a routine setting.MethodNinety-seven people with bulimia nervosa or eating disorder NOS were randomised to either CD–ROM without support for 3 months followed by a flexible number of therapist sessions or to a 3-month waiting list followed by 15 sessions of therapist cognitive–behavioural therapy (CBT) (ISRCTN51564819). Clinical symptoms were assessed at pre-treatment 3 months and 7 months.ResultsOnly two-thirds of participants started treatment. Although there were significant group × time interactions for bingeing and vomiting, favouring the CD–ROM group at 3 months and the waiting-list group at 7 months, post hoc group comparisons at 3 and 7 months found no significant differences for bingeing or vomiting. CD–ROM-based delivery of this intervention, without support from a clinician, may not be the best way of exploiting its benefits.

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The Cost-Effectiveness of Using PARO, a Therapeutic Robotic Seal, to Reduce Agitation and Medication Use in Dementia: Findings from a Cluster–Randomized Controlled Trial

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2017.10.008 ◽

2018 ◽

Vol 19 (7) ◽

pp. 619-622.e1 ◽

Cited By ~ 22

Author(s):

Merehau C. Mervin ◽

Wendy Moyle ◽

Cindy Jones ◽

Jenny Murfield ◽

Brian Draper ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cost Effectiveness ◽

Controlled Trial ◽

Medication Use ◽

Cluster Randomized Controlled Trial ◽

Randomized Controlled ◽

Cluster Randomized ◽

The Cost

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Cost-effectiveness of computerized cognitive–behavioural therapy for the treatment of depression in primary care: findings from the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial

Psychological Medicine ◽

10.1017/s0033291717000289 ◽

2017 ◽

Vol 47 (10) ◽

pp. 1825-1835 ◽

Cited By ~ 7

Author(s):

A. Duarte ◽

S. Walker ◽

E. Littlewood ◽

S. Brabyn ◽

C. Hewitt ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Cognitive Behavioural Therapy ◽

Cost Effective ◽

Behavioural Therapy ◽

Scenario Analyses ◽

Cognitive Behavioural ◽

Life Years ◽

Gp Care ◽

The Cost

BackgroundComputerized cognitive–behavioural therapy (cCBT) forms a core component of stepped psychological care for depression. Existing evidence for cCBT has been informed by developer-led trials. This is the first study based on a large independent pragmatic trial to assess the cost-effectiveness of cCBT as an adjunct to usual general practitioner (GP) care compared with usual GP care alone and to establish the differential cost-effectiveness of a free-to-use cCBT programme (MoodGYM) in comparison with a commercial programme (Beating the Blues) in primary care.MethodCosts were estimated from a healthcare perspective and outcomes measured using quality-adjusted life years (QALYs) over 2 years. The incremental cost-effectiveness of each cCBT programme was compared with usual GP care. Uncertainty was estimated using probabilistic sensitivity analysis and scenario analyses were performed to assess the robustness of results.ResultsNeither cCBT programme was found to be cost-effective compared with usual GP care alone. At a £20 000 per QALY threshold, usual GP care alone had the highest probability of being cost-effective (0.55) followed by MoodGYM (0.42) and Beating the Blues (0.04). Usual GP care alone was also the cost-effective intervention in the majority of scenario analyses. However, the magnitude of the differences in costs and QALYs between all groups appeared minor (and non-significant).ConclusionsTechnically supported cCBT programmes do not appear any more cost-effective than usual GP care alone. No cost-effective advantage of the commercially developed cCBT programme was evident compared with the free-to-use cCBT programme. Current UK practice recommendations for cCBT may need to be reconsidered in the light of the results.

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