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Randomized Controlled Trial
. 2017 May 17;7(5):e015246.
doi: 10.1136/bmjopen-2016-015246.

Cost-effectiveness of therapist-guided internet-delivered cognitive behaviour therapy for paediatric obsessive-compulsive disorder: results from a randomised controlled trial

Fabian Lenhard  1   2 , Richard Ssegonja  3 , Erik Andersson  1 , Inna Feldman  3 , Christian Rück  1   2 , David Mataix-Cols  1   2 , Eva Serlachius  1   2
Affiliations
Randomized Controlled Trial

Cost-effectiveness of therapist-guided internet-delivered cognitive behaviour therapy for paediatric obsessive-compulsive disorder: results from a randomised controlled trial

Fabian Lenhard et al. BMJ Open. .

Erratum in

Abstract

Objectives: To evaluate the cost-effectiveness of a therapist-guided internet-delivered cognitive behaviour therapy (ICBT) intervention for adolescents with obsessive-compulsive disorder (OCD) compared with untreated patients on a waitlist.

Design: Single-blinded randomised controlled trial.

Setting: A research clinic within the regular child and adolescent mental health service in Stockholm, Sweden.

Participants: Sixty-seven adolescents (12-17 years) with a Diagnostic and Statistical Manual of Mental Disorders Fifth Edition diagnosis of OCD.

Interventions: Either a 12-week, therapist-guided ICBT intervention or a wait list condition of equal duration.

Primary outcome measures: Cost data were collected at baseline and after treatment, including healthcare use, supportive resources, prescription drugs, prescription-free drugs, school absence and productivity loss, as well as the cost of ICBT. Health outcomes were defined as treatment responder rate and quality-adjusted life years gain. Bootstrapped mixed model analyses were conducted comparing incremental costs and health outcomes between the groups from the societal and healthcare perspectives.

Results: Compared with waitlist control, ICBT generated substantial societal cost savings averaging US$-144.98 (95% CI -159.79 to -130.16) per patient. The cost reductions were mainly driven by reduced healthcare use in the ICBT group. From the societal perspective, the probability of ICBT being cost saving compared with waitlist control was approximately 60%. From the healthcare perspective, the cost per additional responder to ICBT compared with waitlist control was approximately US$78.

Conclusions: The results suggest that therapist-guided ICBT is a cost-effective treatment and results in societal cost savings, compared with patients who do not receive evidence-based treatment. Since, at present, most patients with OCD do not have access to evidence-based treatments, the results have important implications for the increasingly strained national and healthcare budgets. Future studies should compare the cost-effectiveness of ICBT with regular face-to-face CBT.

Trial registration number: NCT02191631.

Keywords: Internet; Obsessive-compulsive disorder; cognitive behavior therapy; cost-effectiveness; pediatric.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study flow chart. ICBT, internet-delivered cognitive behaviour therapy.
Figure 2
Figure 2
Mean cost changes from baseline to post-treatment for ICBT and waitlist (US$). ICBT, internet-delivered cognitive behaviour therapy.
Figure 3
Figure 3
Cost-effectiveness acceptability curve. ICBT, internet-derived cognitive behaviour therapy.
See this image and copyright information in PMC

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