Cost-effectiveness and long-term follow-up of three forms of minimal-contact cognitive behaviour therapy for severe health anxiety: Results from a randomised controlled trial

Axelsson, Erland; Andersson, Erik; Ljótsson, Brjánn; Hedman‐Lagerlöf, Erik

doi:10.1016/j.brat.2018.06.002

Cited by 20 publications

(44 citation statements)

References 239 publications

(326 reference statements)

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“…The use of telephone and videoconferencing interviews allowed participants of all backgrounds to be engaged and recruited, particularly those who may have been resistant or unable to access traditional mental health services. Most participants were recruited through usual care clinical encounters, particularly in primary care, rather than large-scale screening procedures in general hospital outpatient departments or direct public adverts used in previous studies [9, 38–40]. The methods used may be more easily incorporated into routine health system procedures than has been typical.…”

Section: Discussionmentioning

confidence: 99%

“…We recognise that using digital technology in the intervention group may have led to the selection of younger participants, although participants up to the age of 79 years utilised RCBT. However, use of the internet does not necessarily mean that older participants could not be recruited, nor that RCBT is ineffective in older adults [38–40].…”

Section: Discussionmentioning

confidence: 99%

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Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: a multicentre randomised controlled trial

Morriss

Patel

Malins

et al. 2019

BMC Med

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BackgroundIt is challenging to engage repeat users of unscheduled healthcare with severe health anxiety in psychological help and high service costs are incurred. We investigated whether clinical and economic outcomes were improved by offering remote cognitive behaviour therapy (RCBT) using videoconferencing or telephone compared to treatment as usual (TAU).MethodsA single-blind, parallel group, multicentre randomised controlled trial was undertaken in primary and general hospital care. Participants were aged ≥18 years with ≥2 unscheduled healthcare contacts within 12 months and scored >18 on the Health Anxiety Inventory. Randomisation to RCBT or TAU was stratified by site, with allocation conveyed to a trial administrator, research assessors masked to outcome. Data were collected at baseline, 3, 6, 9 and 12 months. The primary outcome was change in HAI score from baseline to six months on an intention-to-treat basis. Secondary outcomes were generalised anxiety, depression, physical symptoms, function and overall health. Health economics analysis was conducted from a health service and societal perspective.ResultsOf the 524 patients who were referred and assessed for trial eligibility, 470 were eligible and 156 (33%) were recruited; 78 were randomised to TAU and 78 to RCBT. Compared to TAU, RCBT significantly reduced health anxiety at six months, maintained to 9 and 12 months (mean change difference HAI –2.81; 95% CI –5.11 to –0.50; P = 0.017). Generalised anxiety, depression and overall health was significantly improved at 12 months, but there was no significant change in physical symptoms or function. RCBT was strictly dominant with a net monetary benefit of £3,164 per participant at a willingness to pay threshold of £30,000. No treatment-related adverse events were reported in either group.ConclusionsRCBT may reduce health anxiety, general anxiety and depression and improve overall health, with considerable reductions in health and informal care costs in repeat users of unscheduled care with severe health anxiety who have previously been difficult to engage in psychological treatment. RCBT may be an easy-to-implement intervention to improve clinical outcome and save costs in one group of repeat users of unscheduled care.Trial registrationThe trial was registered at ClinicalTrials.gov on 19 Nov 2014 with reference number NCT02298036Electronic supplementary materialThe online version of this article (10.1186/s12916-019-1253-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: a multicentre randomised controlled trial

Morriss

Patel

Malins

et al. 2019

BMC Med

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“…The overarching aim of including such outcomes in this review was to produce an overview of the relative cost-effectiveness and cost-utility of conditions that had been directly compared for health anxiety in an RCT. Whenever possible, we strived to present results from cost-effectiveness and cost-utility analyses based on the Incremental Cost-Effectiveness Ratio (ICER), which is 'the difference in cost per difference in effect, for a particular pairwise comparison of [conditions], given a particular time frame, and, in terms of cost, given a particular stakeholder's perspective' [56]. As to efficacy measures, for cost-effectiveness analyses we were willing to accept either continuous scales or dichotomous outcomes such as remission rates, as long as these were valid measures of health anxiety.…”

Section: Cost-effectiveness and Cost-utilitymentioning

confidence: 99%

“…There was a small and non-significant pooled within-group effect on health anxiety from post-treatment to follow-up 6 months after treatment (k = 3, g = 0.16, 95% CI: −0.08-0.39; I 2 = 0%). Two trials reported outcomes at 12 months follow-up [56,68], and the mean level of health anxiety was sustained in both cases.…”

Section: Efficacy Of Therapist-guided Internet-delivered Cbtmentioning

confidence: 99%

“…Due to the scarcity of studies and different methods used we did not pool cost-effectiveness estimates using meta-analysis. Six RCTs reported health economic outcomes in terms of costeffectiveness and cost-utility [56,60,61,68,70,71], see Table 4. Three of these were based in Sweden and concerned therapist-guided Internet-delivered CBT and other minimal-contact CBT formats.…”

Section: Cost-effectiveness and Cost-utilitymentioning

confidence: 99%

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Cognitive behavior therapy for health anxiety: systematic review and meta-analysis of clinical efficacy and health economic outcomes

Axelsson

Hedman‐Lagerlöf

2019

Expert Review of Pharmacoeconomics & Outcomes Research

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Introduction: Health anxiety, also known as 'hypochondriasis', is a common, distressing and costly condition that responds to cognitive behavior therapy (CBT) but evidence pertaining to response and remission rates, treatment in routine care, therapist-guided Internet-delivered CBT (ICBT) and health economics has not been systematically reviewed. Areas covered: In this systematic review and meta-analysis we searched PubMed, PsycINFO, and OATD (17/06/2019) for randomized controlled trials (RCTs) comparing CBT to non-CBT controls for health anxiety. Based on 19 RCTs, the pooled between-group effect on health anxiety was moderate to large (g = 0.79; 95% CI: 0.57-1.01; adjusted for publication bias: g = 0.62), with small to moderate effects on secondary symptoms and effects largely sustained 12-18 months after treatment. Moderators were control condition and recruitment path, but not treatment setting. The pooled CBT response rate was 66%, and the remission rate 48%. ICBT had effects comparable to face-to-face CBT. CBT for health anxiety is probably cost-effective, but with limited effect on the quality of life. Expert opinion: CBT is a highly efficacious and probably cost-effective treatment for health anxiety. We recommend that ICBT is implemented more widely, and that health economic outcomes and ways of increasing response and remission rates are explored further.

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Systematic Review and Critique of Methods for Economic Evaluation of Digital Mental Health Interventions

Janković

Bojke

Marshall

et al. 2020

Appl Health Econ Health Policy

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Cost-effectiveness and long-term follow-up of three forms of minimal-contact cognitive behaviour therapy for severe health anxiety: Results from a randomised controlled trial

Cited by 20 publications

References 239 publications

Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: a multicentre randomised controlled trial

Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: a multicentre randomised controlled trial

Cognitive behavior therapy for health anxiety: systematic review and meta-analysis of clinical efficacy and health economic outcomes

Systematic Review and Critique of Methods for Economic Evaluation of Digital Mental Health Interventions

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