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. (August 2018)

• Record Type: Journal Article
• Authors: Axelsson, Erland; Andersson, Erik; Ljótsson, Brjánn; Hedman-Lagerlöf, Erik
• Is Part Of: Behaviour research and therapy. Volume 107(2018)
• Page Start: 95
• Page End: 105
• Publication Date: 2018-08
• Subjects: Bibliotherapy -- Cognitive behaviour therapy -- Cost effectiveness -- Health anxiety -- Illness anxiety disorder -- Internet therapy -- Somatic symptom disorder; BIB-CBT cognitive behavioural bibliotherapy -- EQ-5D EuroQol 5D -- G-ICBT therapist-guided internet cognitive behaviour therapy -- HAI 64-item Health anxiety inventory -- ICER incremental cost-effectiveness ratio -- QALYs quality-adjusted life years -- SHA severe health anxiety -- TIC-P Trimbos and Institute of medical technology assessment cost questionnaire on costs associated with psychiatric illness -- U-ICBT unguided internet cognitive behaviour therapy -- WLC waiting-list control condition; Cognitive therapy -- Periodicals; Psychotherapy -- Periodicals; 616.891
• DOI: 10.1016/j.brat.2018.06.002
• Languages: English
• ISSNs: 0005-7967

Abstract

Abstract: Strategies to increase the availability of cognitive behaviour therapy (CBT) for severe health anxiety (SHA) are needed, and this study investigated the cost-effectiveness and long-term efficacy of three forms of minimal-contact CBT for SHA. We hypothesised that therapist-guided internet CBT (G-ICBT), unguided internet CBT (U-ICBT), and cognitive behavioural bibliotherapy (BIB-CBT) would all be more cost-effective than a waiting-list condition (WLC), as assessed over the main phase of the trial. We also hypothesised that improvements would remain stable up to one-year follow-up. Adults ( N = 132) with principal SHA were randomised to 12 weeks of G-ICBT, U-ICBT, BIB-CBT, or WLC. The primary measure of cost-effectiveness was the incremental cost-effectiveness ratio, or the between-group difference in per capita costs divided by the between-group difference in proportion of participants in remission. The Health anxiety inventory (HAI) was the primary efficacy outcome. G-ICBT, U-ICBT, and BIB-CBT were more cost-effective than the WLC. Over the follow-up period, the G-ICBT and BIB-CBT groups made further improvements in health anxiety, whereas the U-ICBT group did not change. As expected, all three treatments were cost-effective with persistent long-term effects. CBT without therapist support appears to be a valuable alternative to G-ICBT for scaling up treatment for SHA. Highlights: Minimal-contact cognitive behaviour therapy for health anxiety is cost-effective. Improvements persist up to one year after treatment termination. Treatment may be delivered via the internet or as bibliotherapy. Treatment may also be delivered with or without therapist support.