Cost-effectiveness and cost-utility of an Acceptance and Commitment Therapy intervention vs. a Cognitive Behavioral Therapy intervention for older adults with anxiety symptoms: A randomized controlled trial

Abstract

Background A previous randomized controlled trial in older adults with anxiety symptoms found no differences between a brief blended Acceptance and Commitment Therapy (ACT) intervention and brief face-to-face Cognitive Behavior Therapy (CBT) regarding anxiety symptom severity at posttreatment and 12-month follow-up. A health-economic evaluation comparing these interventions has not yet been conducted. Objective This study examined the one-year cost-effectiveness and cost-utility of blended ACT compared to face-to-face CBT for older adults with anxiety symptoms. Methods The economic evaluation was embedded in a randomized controlled trial comparing blended ACT to CBT in 314 older adults with mild to moderately severe anxiety symptoms. Data were collected at baseline and 3, 6 and 12 months post baseline. For the cost-effectiveness analysis, treatment response was defined as a reliable improvement in anxiety symptom severity (measured with the Generalized Anxiety Disorder-7) between baseline and 12-month follow-up. To assess cost-utility, quality-adjusted life years (QALYs) were computed using EuroQol-5 Dimensions-5 Levels-5 utility scores. Analyses took the societal perspective, including both healthcare costs and productivity costs. Incremental cost-effectiveness ratios were calculated using 2500 bootstraps of seemingly unrelated regression equations of costs and effects. Sensitivity analyses were performed to assess the robustness of the findings. Results Differences between the blended ACT group and CBT group in treatment response and QALYs were statistically insignificant and clinically irrelevant. The ACT intervention was associated with an average per-participant cost reduction of €466 ($593) compared to CBT, which resulted from lower productivity costs in the blended ACT group. From a healthcare perspective, the ACT intervention was associated with higher costs (by €71 ($90)) than CBT. Conclusions The results do not indicate that from a health-economic perspective blended ACT should be preferred over CBT in the treatment of older adults with anxiety symptoms. The findings support a model of shared decision making, where clinicians and patients collaboratively decide on the preferred intervention, based on ethical-medical, practical and personal considerations. Trial registration Netherlands Trial Register: TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131.

Application and Challenges of the Technology Acceptance Model in Elderly Healthcare: Insights from ChatGPT

“…Community outreach campaigns and government incentives further encourage technology adoption by raising awareness and rewarding businesses that contribute to digital inclusion. By combining these measures, a holistic approach can bridge the digital divide, providing equal opportunities for technology adoption among all segments of the elderly population, irrespective of economic, educational, or cultural factors [18,66,67].…”

“…Frequent testing and feedback sessions with the target demographic ensure continuous improvement, while collaboration with healthcare professionals ensures technology aligns with medical protocols. Through these tailored measures, healthcare providers can create a more inclusive and supportive environment, facilitating effective adoption and utilization of healthcare technologies among elderly individuals facing health conditions or cognitive impairment [6,18,21,69].…”

“…Over the years, TAM has been extended and modified to incorporate additional factors and variables that may impact technology acceptance [2,3,15,16]. TAM2, TAM3, and the Unified Theory of Acceptance and Use of Technology (UTAUT) are examples of extended models that consider social influence, cognitive instrumental processes, and other contextual factors [4,15,16,18]. In the healthcare context, TAM has proven to be valuable for understanding how individuals, especially the elderly, approach and integrate healthcare technologies into their lives [3,4,6,19].…”

“…Digital Divide Concerns:ChatGPT acknowledges the existence of a digital divide, where disparities in access to and proficiency in[18,66,67] …”

“…ChatGPT acknowledges the existence of a digital divide, where disparities in access to and proficiency in technology may disproportionately affect certain segments of the elderly population. Economic, educational, and cultural factors contribute to this divide, hindering equal opportunities for technology adoption[18,66,67] …”