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

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

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Modelling the cost-effectiveness of person-centred care for patients with acute coronary syndrome

The European Journal of Health Economics ◽

10.1007/s10198-020-01230-8 ◽

2020 ◽

Vol 21 (9) ◽

pp. 1317-1327 ◽

Cited By ~ 1

Author(s):

Laura Pirhonen ◽

Hanna Gyllensten ◽

Andreas Fors ◽

Kristian Bolin

Keyword(s):

Monte Carlo ◽

Acute Coronary Syndrome ◽

Cost Effectiveness ◽

Usual Care ◽

Time Perspective ◽

Controlled Trial ◽

Cost Effective ◽

Sensitivity Analyses ◽

Coronary Syndrome ◽

The Cost

Abstract Background Person-centred care has been shown to be cost-effective compared to usual care for several diseases, including acute coronary syndrome, in a short-term time perspective (< 2 years). The cost-effectiveness of person-centred care in a longer time perspective is largely unknown. Objectives To estimate the mid-term cost-effectiveness of person-centred care compared to usual care for patients (< 65) with acute coronary syndrome, using a 2-year and a 5-year time perspective. Methods The mid-term cost-effectiveness of person-centred care compared to usual care was estimated by projecting the outcomes observed in a randomized-controlled trial together with data from health registers and data from the scientific literature, 3 years beyond the 2-year follow-up, using the developed simulation model. Probabilistic sensitivity analyses were performed using Monte Carlo simulation. Results Person-centred care entails lower costs and improved effectiveness as compared to usual care, for a 2-year time and a 5-year perspective. Monte Carlo simulations suggest that the likelihoods of the person-centred care being cost-effective compared to usual care were between 80 and 99% and between 75 and 90% for a 2-year and a 5-year time perspective (using a 500,000 SEK/QALY willingness-to-pay threshold). Conclusions Person-centred care was less costly and more effective compared to usual care in a 2-year and a 5-year time perspective for patients with acute coronary syndrome under the age of 65.

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

SLEEP ◽

10.1093/sleep/zsaa223 ◽

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.

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P0434COST-EFFECTIVENESS OF MAINTANCE THERAPY WITH AZATHIOPRIME VERSUS RITUXIMAB (TAILORED OR FIXED-SCHEDULE) IN ADULTS WITH GENERALIZED ANCA VASCULITIS IN COLOMBIA

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0434 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Kateir Mariel Contreras ◽

Viviana Orozco Ortiz ◽

Eduardo José Puche ◽

Paola Karina Garcia ◽

Camilo Alberto Gonzalez ◽

...

Keyword(s):

Cost Effectiveness ◽

Lower Cost ◽

Transition Probabilities ◽

Cost Effective ◽

Sensitivity Analyses ◽

Fixed Dose ◽

National Guidelines ◽

Anca Vasculitis ◽

Life Years ◽

The Cost

Abstract Background and Aims Azathioprine has been for decades the drug of choice for maintenance therapy in patients with generalized ANCA vasculitis in remission. However, recent studies show that rituximab, a high-cost biological agent, which can be administrated in two different schedules, might be more effective, so it is necessary to know the cost- effectiveness. Our goal was to compare the cost-effectiveness of the 3 maintenance schemes: standard therapy with azathioprine; fixed-dose rituximab and rituximab tailored according to CD19 lymphocyte level and ANCA titres, from the perspective of the Colombian healthcare system. Method We designed a 5-year annual cycle Markov model with the following stages: remission, minor relapse, mayor relapse and death. Transition probabilities were obtained from a systematic review of the literature (Scopus and Pubmed). Following national guidelines for economic studies, costs (in 2018, 1 euro = 3489 Colombian pesos) were estimated based on national drug registries, and official tariff manuals for procedures and other resources. Main outcome was quality-adjusted life years (QALY), using lupus nephropathy as a proxy; values were obtained from Tufts CEA Registry and validated by local expert panel through a modified Delphi technique. Cost-effectiveness threshold was three-times per capita GDP (16.872 euros). Discount rate was 5%. Univariate and probabilistic sensitivity analyses were performed. Results Overall discounted 5-years costs were € 1149 for azathioprine; € 4025 for tailored rituximab and € 5221 for fixed rituximab. QALY gains were 2.94, 3.63 and 3.64, respectively. Both tailored and fixed rituximab were cost-effective (cost per QALY gained: € 4168 and € 5817 respectively), but tailored dosing was preferable due to its lower cost. Sensitivity analyses did not modify these results significantly. Conclusion To our knowledge this is the first economic evaluation that compare azathioprine with tailored and fixed rituximab regimens as a vasculitis maintenance treatment in adults with ANCA generalized. Due to its lower effectiveness azathioprine should not be the first line of treatment. Tailored rituximab should be a better option than fixed schedule due to its lower cost with similar effectiveness.

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Moodle: The cost effective solution for internet cognitive behavioral therapy (I-CBT) interventions

Technology and Health Care ◽

10.3233/thc-161261 ◽

2017 ◽

Vol 25 (1) ◽

pp. 163-165 ◽

Cited By ~ 17

Author(s):

Melvyn W.B. Zhang ◽

Roger C.M. Ho

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cost Effective ◽

Cognitive Behavioral ◽

Effective Solution ◽

The Cost

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The Cost-Effectiveness of Group Cognitive Behavioral Therapy Compared with Routine Primary Care for Women with Postnatal Depression in the UK

Value in Health ◽

10.1111/j.1524-4733.2010.00720.x ◽

2010 ◽

Vol 13 (5) ◽

pp. 580-584 ◽

Cited By ~ 9

Author(s):

Matt D. Stevenson ◽

Alison Scope ◽

Paul A. Sutcliffe

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Cognitive Behavioral Therapy ◽

Postnatal Depression ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

The Uk ◽

The Cost

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The cost effectiveness of cognitive behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

Behaviour Research and Therapy ◽

10.1016/j.brat.2009.02.006 ◽

2009 ◽

Vol 47 (6) ◽

pp. 451-453 ◽

Cited By ~ 39

Author(s):

Scott J. Crow ◽

James E. Mitchell ◽

Ross D. Crosby ◽

Sonja A. Swanson ◽

Stephen Wonderlich ◽

...

Keyword(s):

Cost Effectiveness ◽

Cognitive Behavioral Therapy ◽

Bulimia Nervosa ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Face To Face ◽

The Cost

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Cost-effectiveness of Mindfulness-based Stress Reduction Versus Cognitive Behavioral Therapy or Usual Care Among Adults With Chronic Low Back Pain

Spine ◽

10.1097/brs.0000000000002344 ◽

2017 ◽

Vol 42 (20) ◽

pp. 1511-1520 ◽

Cited By ~ 16

Author(s):

Patricia M. Herman ◽

Melissa L. Anderson ◽

Karen J. Sherman ◽

Benjamin H. Balderson ◽

Judith A. Turner ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Cost Effectiveness ◽

Cognitive Behavioral Therapy ◽

Usual Care ◽

Stress Reduction ◽

Chronic Low Back Pain ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Low Back

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The Cost Effectiveness of Naltrexone Added to Cognitive-Behavioral Therapy in the Treatment of Alcohol Dependence

Journal of Addictive Diseases ◽

10.1080/10550880902772456 ◽

2009 ◽

Vol 28 (2) ◽

pp. 137-144 ◽

Cited By ~ 18

Author(s):

David Walters ◽

Jason P. Connor ◽

Gerald F. X. Feeney ◽

Ross McD Young

Keyword(s):

Cost Effectiveness ◽

Cognitive Behavioral Therapy ◽

Alcohol Dependence ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

The Cost

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

BMC Health Services Research ◽

10.1186/s12913-021-07153-1 ◽

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.

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