August 06, 2021
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Aspvall and seven other authors report that they received numerous grants while conducting the study. Please refer to the study for information on these grants and for any relevant financial information from the other authors.
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According to an economic evaluation of a randomized non-inferiority study published in JAMA Network Open, a staged cognitive behavioral therapy model was cost-effective for children and adolescents with obsessive-compulsive disorder.
“In order to increase the availability of high-quality CBT, we have developed an internet-based CBT program for children and adolescents with OCD, led by therapists and parents.” Kristina Aspvall, PhD, of the Center for Psychiatry Research in the Clinical Neuroscience Department of the Karolinska Institutet in Sweden, and colleagues wrote. “Families work their way through a range of interactive online CBT modules and receive asynchronous support from a clinician through a dedicated online platform. This low-intensity intervention has demonstrated effectiveness and cost-effectiveness in three open-label studies and one randomized clinical superiority study on the waiting list. “
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Aspvall and colleagues aimed to evaluate the cost-effectiveness of guided CBT conducted over the Internet and implemented in a tiered care model compared to personally administered CBT for young people with OCD. The randomized non-inferiority study they analyzed took place in two specialized OCD clinics in Sweden and included 152 children and adolescents aged 8 to 17 years (62% girls; mean age 13.4 years) with obsessive-compulsive disorder, 72% of whom were medically related Transfers came. Through random referral, participants received either a guided CBT over the internet or a face-to-face CBT over 16 weeks. Non-responders in both groups had the opportunity to conduct additional personal CBT therapy sessions in a 3-month follow-up. The response rates served as the primary endpoint, and remission rates and quality-adjusted years of life as further endpoints. The researchers analyzed cost data collected before and after treatment, as well as at the 3-month and 6-month follow-up. They compared the differences between the groups in incremental costs and health outcomes and presented them from the perspective of health workers, the health sector and society.
A total of 50 of 74 participants (68%) in the step treatment group and 52 of 77 participants (68%) in the CBT group responded to the treatment on site (OR = 1; 95% CI 0.51-1.98) . According to health economic analyzes, the participants in the tiered treatment group consumed fewer therapist resources compared to the CBT group on site, resulting in an average cost saving of USD 2,104 per participant for the entire study period of 10 months. This corresponded to a relative saving of 39%. From a broader perspective of the health sector and society, the cost savings remained broadly comparable, according to the researchers
“This study suggests that a tiered care model, in which young people with OCD are first offered an inexpensive digital CBT intervention, followed by traditional personal therapy for non-responders, is just as effective and less expensive than the traditional in-office treatment format.” wrote Aspvall and colleagues. “The results have important implications for clinical practice and health policy.”
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