Kumar Shefali, Jones Bell Megan, Juusola Jessie L
Evidation Health, San Mateo, California, United States of America.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, United States of America.
PLoS One. 2018 Jan 4;13(1):e0190554. doi: 10.1371/journal.pone.0190554. eCollection 2018.
Generalized anxiety disorder (GAD) is a debilitating mental health illness that affects approximately 3.1% of U.S. adults and can be treated with cognitive behavioral therapy (CBT). With the emergence of digital health technologies, mobile CBT may be a cost-effective way to deliver care. We developed an analysis framework to quantify the cost-effectiveness of internet-based CBT for individuals with GAD. As a case study, we examined the potential value of a new mobile-delivered CBT program for GAD.
We developed a Markov model of GAD health states combined with a detailed economic analysis for a cohort of adults with GAD in the U.S. In our case study, we used pilot program efficacy data to evaluate a mobile CBT program as either prevention or treatment only and compared the strategies to traditional CBT and no CBT. Traditional CBT efficacy was estimated from clinical trial results. We calculated discounted incremental costs and quality-adjusted life-years (QALYs) over the cohort lifetime.
In the base case, for a cohort of 100,000 persons with GAD, we found that mobile CBT is cost-saving. It leads to a gain of 34,108 QALYs and 81,492 QALYs and a cost reduction of $2.23 billion and $4.54 billion when compared to traditional CBT and no CBT respectively. Results were insensitive to most model inputs and mobile CBT remained cost-saving in almost all scenarios.
The case study was conducted for illustrative purposes and used mobile CBT efficacy data from a small pilot program; the analysis should be re-conducted once robust efficacy data is available. The model was limited in its ability to measure the effectiveness of CBT in combination with pharmacotherapy.
Mobile CBT may lead to improved health outcomes at lower costs than traditional CBT or no intervention and may be effective as either prevention or treatment.
广泛性焦虑障碍（GAD）是一种使人衰弱的心理健康疾病，影响着约3.1%的美国成年人，可通过认知行为疗法（CBT）进行治疗。随着数字健康技术的出现，移动认知行为疗法可能是一种具有成本效益的提供护理的方式。我们开发了一个分析框架，以量化基于互联网的认知行为疗法对广泛性焦虑障碍患者的成本效益。作为一个案例研究，我们考察了一种新的针对广泛性焦虑障碍的移动认知行为疗法项目的潜在价值。
我们开发了一个广泛性焦虑障碍健康状态的马尔可夫模型，并结合对美国一组广泛性焦虑障碍成年人的详细经济分析。在我们的案例研究中，我们使用试点项目疗效数据来评估移动认知行为疗法项目仅作为预防或治疗的效果，并将这些策略与传统认知行为疗法和不进行认知行为疗法进行比较。传统认知行为疗法的疗效是根据临床试验结果估算的。我们计算了该队列人群一生中的贴现增量成本和质量调整生命年（QALY）。
在基础案例中，对于一组100,000名广泛性焦虑障碍患者，我们发现移动认知行为疗法具有成本节约效益。与传统认知行为疗法和不进行认知行为疗法相比，它分别带来了34,108个和81,492个质量调整生命年的增加，以及22.3亿美元和45.4亿美元的成本降低。结果对大多数模型输入不敏感，并且在几乎所有情况下移动认知行为疗法都保持成本节约效益。
该案例研究是为说明目的而进行的，并且使用了来自一个小型试点项目的移动认知行为疗法疗效数据；一旦有可靠的疗效数据，应重新进行分析。该模型在衡量认知行为疗法与药物疗法联合使用的有效性方面能力有限。
移动认知行为疗法可能以低于传统认知行为疗法或不干预的成本带来更好的健康结果，并且作为预防或治疗可能都是有效的。
