Objective To assess whether exposure-based internet-delivered cognitive–behavioural therapy (internet-CBT) is a cost-effective treatment for adolescents with irritable bowel syndrome (IBS) compared with a waitlist control, from a societal perspective, based on data from a randomised trial.
Design Within-trial cost-effectiveness analysis.
Setting Participants were recruited from the whole of Sweden via primary, secondary and tertiary care clinics reached through news media and advertising.
Participants Adolescents (aged 13–17) with a diagnosis of IBS.
Interventions Participants were randomised to either an exposure-based internet-CBT, including 10 weekly modules for adolescents and five modules for parents, or a waitlist.
Outcome measures The main health outcome was the quality-adjusted life-year (QALY) estimated by mapping Pediatric Quality-of-Life Inventory (PedsQL) scores onto EQ-5D-3L utilities. The secondary outcome was the point improvement on the PedsQL scale. Data on health outcomes and resource use were collected at baseline and 10 weeks post-treatment. Resource use was measured using the Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry (TIC-P) . Incremental cost-effectiveness ratios (ICER) were calculated as the difference in average costs by the difference in average outcomes between groups.
Results The base-case results showed that internet-CBT costs were on average US$170.24 (95% CI 63.14 to 315.04) more per participant than the waitlist. Adolescents in the internet-CBT group showed small QALY gains (0.0031; 95% CI 0.0003 to 0.0061), and an average improvement of 5.647 points (95% CI 1.82 to 9.46) on the PedsQL compared with the waitlist. Internet-CBT yielded an ICER of $54 916/QALY gained and a probability of cost-effectiveness of 74% given the Swedish willingness-to-pay threshold. The ICER for the outcome PedsQL was US$85.29/point improvement.
Conclusions Offering internet-CBT to adolescents with IBS improves health-related quality of life and generates small QALY gains at a higher cost than a waitlist control. Internet-CBT is thus likely to be cost-effective given the strong efficacy evidence, small QALY gains and low cost.
Trial registration number NCT02306369; Results.
- cognitive-behaviour therapy
- irritable bowel syndrome
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Patient consent for publication Not required.
Contributors MB, OO, EH, ES and BL designed the trial. MB, OO, ML, EH, FL, ES and BL contributed to data collection. FS, RS and IF were the trial health economists and conceived the economic evaluation. FS and RS analysed the data. FS drafted the manuscript. All authors contributed to data interpretation and approved the final manuscript.
Funding This study was supported by grants from the Jan and Dan Olsson Foundation (4-1559/2013), the Swedish Research Council (521-2013-2846), the Kempe-Carlgren Foundation, the Ruth and Richard Julin Foundation (2012Juli0048), the Majblomman Foundation, the Ishizu Matsumurais Donation, the Bengt Ihre Foundation (SLS-331861), the Bengt Ihre Research Fellowship in Gastroenterology, the Swedish Society of Medicine (SLS331681, SLS-410501), the Stockholm County Council (ALF) and the Swedish Research Council for Health, Working Life and Welfare (2014-4052). Financial support was also provided through the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet (20130129).
Disclaimer None of the funding bodies had any influence on study design, implementation, data analysis or interpretation.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data requests should be made to the corresponding author.