RT Journal Article
SR Electronic
T1 Cost-effectiveness of internet-delivered cognitive–behavioural therapy for adolescents with irritable bowel syndrome
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e023881
DO 10.1136/bmjopen-2018-023881
VO 9
IS 1
A1 Filipa Sampaio
A1 Marianne Bonnert
A1 Ola Olén
A1 Erik Hedman
A1 Maria Lalouni
A1 Fabian Lenhard
A1 Brjánn Ljótsson
A1 Richard Ssegonja
A1 Eva Serlachius
A1 Inna Feldman
YR 2019
UL http://bmjopen.bmj.com/content/9/1/e023881.abstract
AB 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.