scholarly journals Cost Effectiveness of Therapist Delivered Cognitive Behavioural Therapy and Web-Based Self-Management in Irritable Bowel Syndrome: The ACTIB Randomised Trial

2021 ◽  
Author(s):  
Paul McCrone ◽  
Hazel Everitt ◽  
Sabine Landau ◽  
Paul Little ◽  
Felicity L. Bishop ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Service Use ◽  
Randomised Trial ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Treatment As Usual ◽  
Web Based ◽  
Life Years ◽  
Irritable Bowel ◽  
One Year

Abstract Background Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiveness of the interventions. Methods Participants were recruited from 74 general practices and three gastroenterology centres in England. Interventions costs were calculated, and other service use and lost employment measured and costed for one-year post randomisation. Quality-adjusted life years (QALYs) were combined with costs to determine cost-effectiveness of TCBT and WCBT compared to TAU.Results TCBT cost £956 more than TAU (95% CI, £601 to £1435) and generated 0.0429 more QALYs. WCBT cost £224 more than TAU (95% CI, -£11 to £448) and produced 0.029 more QALYs. Compared to TAU, TCBT had an incremental cost per QALY of £22,284 while the figure for WCBT was £7724. After multiple imputation these ratios increased to £27,436 and £17,388 respectively. Including lost employment and informal care, TCBT had costs that were on average £866 lower than TAU (95% CI, -£1133 to £2957), and WCBT had costs that were £1028 lower than TAU (95% CI, -£448 to £2580).Conclusions TCBT and WCBT resulted in more QALYs and higher costs than TAU. Complete case analysis suggests both therapies are cost-effective from a healthcare perspective. Imputation for missing data reduces cost-effectiveness but WCTB remained cost-effective. If the reduced societal costs are included both interventions are likely to be more cost-effective.Trial registration ISRCTN44427879 (registered 18.11.13)

scholarly journals Cost effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome: the ACTIB randomised trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Paul McCrone ◽  
Hazel Everitt ◽  
Sabine Landau ◽  
Paul Little ◽  
Felicity L. Bishop ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Service Use ◽  
Randomised Trial ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Treatment As Usual ◽  
Web Based ◽  
Life Years ◽  
Irritable Bowel ◽  
One Year

Abstract Background Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiveness of the interventions. Methods Participants were recruited from 74 general practices and three gastroenterology centres in England. Interventions costs were calculated, and other service use and lost employment measured and costed for one-year post randomisation. Quality-adjusted life years (QALYs) were combined with costs to determine cost-effectiveness of TCBT and WCBT compared to TAU. Results TCBT cost £956 more than TAU (95% CI, £601–£1435) and generated 0.0429 more QALYs. WCBT cost £224 more than TAU (95% CI, − £11 to £448) and produced 0.029 more QALYs. Compared to TAU, TCBT had an incremental cost per QALY of £22,284 while the figure for WCBT was £7724. After multiple imputation these ratios increased to £27,436 and £17,388 respectively. Including lost employment and informal care, TCBT had costs that were on average £866 lower than TAU (95% CI, − £1133 to £2957), and WCBT had costs that were £1028 lower than TAU (95% CI, − £448 to £2580). Conclusions TCBT and WCBT resulted in more QALYs and higher costs than TAU. Complete case analysis suggests both therapies are cost-effective from a healthcare perspective. Imputation for missing data reduces cost-effectiveness but WCTB remained cost-effective. If the reduced societal costs are included both interventions are likely to be more cost-effective. Trial registration ISRCTN44427879 (registered 18.11.13).

scholarly journals Cost-effectiveness analysis of a placebo-controlled randomized trial evaluating the effectiveness of arthroscopic subacromial decompression in patients with subacromial shoulder pain

2019 ◽  
Vol 101-B (1) ◽  
pp. 55-62 ◽  
Author(s):  
I. Rombach ◽  
N. Merritt ◽  
B. A. Shirkey ◽  
J. L. Rees ◽  
J. A. Cook ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Service Use ◽  
Care Service ◽  
Health Care Service ◽  
Cost Effective ◽  
Subacromial Decompression ◽  
Treatment Comparison ◽  
Use Of Resources ◽  
Life Years ◽  
One Year

Aims The aims of this study were to compare the use of resources, costs, and quality of life outcomes associated with subacromial decompression, arthroscopy only (placebo surgery), and no treatment for subacromial pain in the United Kingdom National Health Service (NHS), and to estimate their cost-effectiveness. Patients and Methods The use of resources, costs, and quality-adjusted life-years (QALYs) were assessed in the trial at six months and one year. Results were extrapolated to two years after randomization. Differences between treatment arms, based on the intention-to-treat principle, were adjusted for covariates and missing data were handled using multiple imputation. Incremental cost-effectiveness ratios were calculated, with uncertainty around the values estimated using bootstrapping. Results Cumulative mean QALYs/mean costs of health care service use and surgery per patient from baseline to 12 months were estimated as 0.640 (standard error (se) 0.024)/£3147 (se 166) in the decompression arm, 0.656 (se 0.020)/£2830 (se 183) in the arthroscopy only arm and 0.522 (se 0.029)/£1451 (se 151) in the no treatment arm. Statistically significant differences in cumulative QALYs and costs were found at six and 12 months for the decompression versus no treatment comparison only. The probabilities of decompression being cost-effective compared with no treatment at a willingness-to-pay threshold of £20 000 per QALY were close to 0% at six months and approximately 50% at one year, with this probability potentially increasing for the extrapolation to two years. Discussion The evidence for cost-effectiveness at 12 months was inconclusive. Decompression could be cost-effective in the longer-term, but results of this analysis are sensitive to the assumptions made about how costs and QALYs are extrapolated beyond the follow-up of the trial.

scholarly journals Cost-effectiveness of internet-based cognitive–behavioural therapy and physical exercise for depression

BJPsych Open ◽  
2018 ◽  
Vol 4 (4) ◽  
pp. 265-273 ◽  
Author(s):  
Martin Kraepelien ◽  
Simon Mattsson ◽  
Erik Hedman-Lagerlöf ◽  
Ingemar F. Petersson ◽  
Yvonne Forsell ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Physical Exercise ◽  
Cognitive Behavioural Therapy ◽  
Service Use ◽  
Controlled Trial ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Life Years

BackgroundBoth internet-based cognitive–behavioural therapy (ICBT) and physical exercise are alternatives to treatment as usual (TAU) in managing mild to moderate depression in primary care.AimsTo determine the cost-effectiveness of ICBT and physical exercise compared with TAU in primary care.MethodEconomic evaluation of a randomised controlled trial (N = 945) in Sweden. Costs were estimated by a service use questionnaire and used together with the effects on quality-adjusted life-years (QALYs). The primary 3-month healthcare provider perspective in primary care was complemented by a 1-year societal perspective.ResultsThe primary analysis showed that incremental cost per QALY gain was €8817 for ICBT and €14 571 for physical exercise compared with TAU. At the established willingness-to-pay threshold of €21 536 (£20 000) per QALY, the probability of ICBT being cost-effective is 90%, and for physical exercise is 76%, compared with TAU.ConclusionsFrom a primary care perspective, both ICBT and physical exercise for depression are likely to be cost-effective compared with TAU.Declaration of interestNone.

scholarly journals Web-based intervention for depressive symptoms in adults with types 1 and 2 diabetes mellitus: a health economic evaluation

2018 ◽  
Vol 212 (4) ◽  
pp. 199-206 ◽  
Author(s):  
Stephanie Nobis ◽  
David Daniel Ebert ◽  
Dirk Lehr ◽  
Filip Smit ◽  
Claudia Buntrock ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Treatment Response ◽  
Active Control ◽  
Cost Effective ◽  
Control Group ◽  
Active Control Group ◽  
Comorbid Depression ◽  
Web Based ◽  
Life Years ◽  
The Cost

BackgroundWeb-based interventions are effective in reducing depression. However, the evidence for the cost-effectiveness of these interventions is scarce.AimsThe aim is to assess the cost-effectiveness of a web-based intervention (GET.ON M.E.D.) for individuals with diabetes and comorbid depression compared with an active control group receiving web-based psychoeducation.MethodWe conducted a cost-effectiveness analysis with treatment response as the outcome and a cost-utility analysis with quality-adjusted life-years (QALYs) alongside a randomised controlled trial with 260 participants.ResultsAt a willingness-to-pay ceiling of €5000 for a treatment response, the intervention has a 97% probability of being regarded as cost-effective compared with the active control group. If society is willing to pay €14 000 for an additional QALY, the intervention has a 51% probability of being cost-effective.ConclusionsThis web-based intervention for individuals with diabetes and comorbid depression demonstrated a high probability of being cost-effective compared with an active control group.Declaration of interestS.N., D.D.E., D.L., M.B. and B.F. are stakeholders of the Institute for Online Health Trainings, which aims to transfer scientific knowledge related to this research into routine healthcare.

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.

scholarly journals Cost-effectiveness analysis of tranexamic acid for the treatment of traumatic brain injury, based on the results of the CRASH-3 randomised trial: a decision modelling approach

2020 ◽  
Vol 5 (9) ◽  
pp. e002716
Author(s):  
Jack Williams ◽  
Ian Roberts ◽  
Haleema Shakur-Still ◽  
Fiona E Lecky ◽  
Rizwana Chaudhri ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Tranexamic Acid ◽  
Randomised Trial ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Risk Of Death ◽  
Life Years ◽  
Markov Decision Model ◽  
The Uk ◽  
The Cost

IntroductionAn estimated 69 million traumatic brain injuries (TBI) occur each year worldwide, with most in low-income and middle-income countries. The CRASH-3 randomised trial found that intravenous administration of tranexamic acid within 3 hours of injury reduces head injury deaths in patients sustaining a mild or moderate TBI. We examined the cost-effectiveness of tranexamic acid treatment for TBI.MethodsA Markov decision model was developed to assess the cost-effectiveness of treatment with and without tranexamic acid, in addition to current practice. We modelled the decision in the UK and Pakistan from a health service perspective, over a lifetime time horizon. We used data from the CRASH-3 trial for the risk of death during the trial period (28 days) and patient quality of life, and data from the literature to estimate costs and long-term outcomes post-TBI. We present outcomes as quality-adjusted life years (QALYs) and 2018 costs in pounds for the UK, and US dollars for Pakistan. Incremental cost-effectiveness ratios (ICER) per QALY gained were estimated, and compared with country specific cost-effective thresholds. Deterministic and probabilistic sensitivity analyses were also performed.ResultsTranexamic acid was highly cost-effective for patients with mild TBI and intracranial bleeding or patients with moderate TBI, at £4288 per QALY in the UK, and US$24 per QALY in Pakistan. Tranexamic acid was 99% and 98% cost-effective at the cost-effectiveness thresholds for the UK and Pakistan, respectively, and remained cost-effective across all deterministic sensitivity analyses. Tranexamic acid was even more cost-effective with earlier treatment administration. The cost-effectiveness for those with severe TBI was uncertain.ConclusionEarly administration of tranexamic acid is highly cost-effective for patients with mild or moderate TBI in the UK and Pakistan, relative to the cost-effectiveness thresholds used. The estimated ICERs suggest treatment is likely to be cost-effective across all income settings globally.

scholarly journals 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

2017 ◽  
Vol 47 (10) ◽  
pp. 1825-1835 ◽  
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.

scholarly journals Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care

BMJ ◽  
2004 ◽  
Vol 328 (7442) ◽  
pp. 747 ◽  
Author(s):  
David Wonderling ◽  
Andrew J Vickers ◽  
Richard Grieve ◽  
Rob McCarney
Keyword(s):  
Cost Effectiveness ◽  
Chronic Headache ◽  
Randomised Trial ◽  
Cost Effectiveness Analysis ◽  
Base Case ◽  
Effectiveness Analysis ◽  
Life Years ◽  
One Year ◽  
The One ◽  
Quality Adjusted Life

AbstractObjective To evaluate the cost effectiveness of acupuncture in the management of chronic headache.Design Cost effectiveness analysis of a randomised controlled trial.Setting General practices in England and Wales.Participants 401 patients with chronic headache, predominantly migraine.Interventions Patients were randomly allocated to receive up to 12 acupuncture treatments over three months from appropriately trained physiotherapists, or to usual care alone.Main outcome measure Incremental cost per quality adjusted life year (QALY) gained.Results Total costs during the one year period of the study were on average higher for the acupuncture group (£403; $768;€598) than for controls (£217) because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the one year of the trial was 0.021 quality adjusted life years (QALYs), leading to a base case estimate of £9180 per QALY gained. This result was robust to sensitivity analysis. Cost per QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial.Conclusions Acupuncture for chronic headache improves health related quality of life at a small additional cost; it is relatively cost effective compared with a number of other interventions provided by the NHS.

scholarly journals Economic Evaluation of CYP2C19 Genotype-Guided Antiplatelet Therapy Compared to Universal use of Ticagrelor or Clopidogrel in Qatar

2020 ◽  
Author(s):  
Sawsan Ibrahim AlMukdad ◽  
Hazem Elewa ◽  
Daoud Al-Badriyeh
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Antiplatelet Therapy ◽  
Cost Effective ◽  
Cyp2c19 Genotype ◽  
Life Years ◽  
One Year ◽  
The One ◽  
Guided Therapy

Background: Patients having CYP2C19 loss-of-function alleles and receiving clopidogrel are at higher risk of adverse cardiovascular outcomes. Ticagrelor is a more effective and expensive antiplatelet that is unaffected by the CYP2C19 polymorphism. The main aim of the current research is to evaluate the cost-effectiveness among CYP2C19 genotype-guided therapy, universal ticagrelor, and universal clopidogrel after a percutaneous coronary intervention (PCI). Methods: A two-part simulation model, including a one-year decision-analytic model and a 20-year followup Markov model, was created to follow the use of (i) universal clopidogrel, (ii) universal ticagrelor, and (iii) genotype-guided antiplatelet therapy. Outcome measures were the incremental cost-effectiveness ratio (ICER, cost/success) and incremental cost-utility ratio (ICUR, cost/qualityadjusted life years [QALY]). Therapy success was defined as survival without myocardial infarction, stroke, cardiovascular death, stent thrombosis, and no therapy discontinuation because of adverse events, i.e. major bleeding and dyspnea. The model was based on a multivariate analysis, and a sensitivity analysis confirmed the robustness of the model outcomes. Results: Against universal clopidogrel, genotype-guided therapy was cost-effective over the one-year duration (ICER, USD 6,102 /success), and dominant over the long-term. Genotype-guided therapy was dominant over universal ticagrelor over the one-year duration and cost-effective over the long term (ICUR, USD 1,383 /QALY). Universal clopidogrel was dominant over ticagrelor over the short term, and cost-effective over the long-term (ICUR, 10,616 /QALY). Conclusion: CYP2C19 genotype-guided therapy appears to be the preferred antiplatelet strategy, followed by universal clopidogrel, and then universal ticagrelor for post-PCI patients in Qatar.

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