Cost-Effectiveness of Therapist-Guided Internet-Based Cognitive Behavioral Therapy for Stress-Related Disorders: Secondary Analysis of a Randomized Controlled Trial
Autor: | Erik Hedman-Lagerlöf, Elfin Lindsäter, Torbjörn Åkerstedt, Mats Lekander, Brjánn Ljótsson, Erland Axelsson, Sigrid Salomonsson, Fredrik Santoft |
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Rok vydání: | 2019 |
Předmět: |
Adult
Male medicine.medical_specialty adjustment disorder Cost effectiveness Cost-Benefit Analysis medicine.medical_treatment exhaustion disorder Adjustment disorders Health Informatics law.invention 03 medical and health sciences 0302 clinical medicine Quality of life Willingness to pay Randomized controlled trial law Humans Medicine 030212 general & internal medicine psychological stress health care economics and organizations Stress Disorders Traumatic Acute Original Paper Internet cost effectiveness Cognitive Behavioral Therapy business.industry Stress-related disorders medicine.disease 030227 psychiatry Cognitive behavioral therapy Treatment Outcome Economic evaluation Quality of Life Physical therapy Female business |
Zdroj: | Journal of Medical Internet Research |
ISSN: | 1438-8871 |
Popis: | Background Stress-related disorders are associated with significant suffering, functional impairment, and high societal costs. Internet-based cognitive behavioral therapy (ICBT) is a promising treatment for stress-related disorders but has so far not been subjected to health economic evaluation. Objective The objective of this study was to evaluate the cost-effectiveness and cost-utility of ICBT for patients with stress-related disorders in the form of adjustment disorder (AD) or exhaustion disorder (ED). We hypothesized that ICBT, compared with a waitlist control (WLC) group, would generate improvements at low net costs, thereby making it cost-effective. Methods Health economic data were obtained in tandem with a randomized controlled trial of a 12-week ICBT in which patients (N=100) were randomized to an ICBT (n=50) or a WLC (n=50) group. Health outcomes and costs were surveyed pre- and posttreatment. We calculated incremental cost-effectiveness ratios (ICERs) based on remission rates and incremental cost-utility ratios (ICURs) based on health-related quality of life. Bootstrap sampling was used to assess the uncertainty of our results. Results The ICER indicated that the most likely scenario was that ICBT led to higher remission rates compared with the WLC and was associated with slightly larger reductions in costs from pre- to posttreatment. ICBT had a 60% probability of being cost-effective at a willingness to pay (WTP) of US $0 and a 96% probability of being cost-effective at a WTP of US $1000. The ICUR indicated that ICBT also led to improvements in quality of life at no net societal cost. Sensitivity analyses supported the robustness of our results. Conclusions The results suggest that ICBT is a cost-effective treatment for patients suffering from AD or ED. Compared with no treatment, ICBT for these patients yields large effects at no or minimal societal net costs. Trial Registration ClinicalTrials.gov NCT02540317; https://clinicaltrials.gov/ct2/show/NCT02540317 |
Databáze: | OpenAIRE |
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