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Cost-effectiveness of therapist-guided internet-delivered cognitive behaviour therapy for paediatric obsessive–compulsive disorder: results from a randomised controlled trial
  1. Fabian Lenhard1,2,
  2. Richard Ssegonja3,
  3. Erik Andersson1,
  4. Inna Feldman3,
  5. Christian Rück1,2,
  6. David Mataix-Cols1,2,
  7. Eva Serlachius1,2
  1. 1 Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  2. 2 Stockholm Healthcare Services, Stockholm County Council, Stockholm, Sweden
  3. 3 Department of Women's and Children's Health (CHAP), Uppsala Universitet, Uppsala, Sweden
  1. Correspondence to Dr Fabian Lenhard; fabian.lenhard{at}


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.

  • Obsessive-compulsive disorder
  • cognitive behavior therapy
  • Internet
  • pediatric
  • cost-effectiveness

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  • Contributors All authors (FL, RS, EA, IF, CR, DM-C, ES) were involved in the conception of the work, and analysis and interpretation of data for the work, drafting the work and revising it critically for important intellectual content, approved the final version of the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was funded by the Stockholm County Council (PPG project 20120167, 20140085), Swedish Research Council for Health, Working Life and Welfare (2014-4052) and Jane & Dan Olsson Foundation. CR was supported by a grant from the Swedish Research Council (K2013-61P-22168).

  • Disclaimer The funders did not have any involvement in the study design, data collection, analysis and interpretation of the data, writing of the report or the decision to submit the article for publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Regional Ethical Review Board in Stockholm, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The anonymised individual participant data will be shared on request to the corresponding author.

  • Correction notice This article has been corrected since it first published. The legends of Figures 2 and 3 have been swapped round as these were typeset in the wrong position.

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