Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden.
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
BMJ Open. 2019 Jan 24;9(1):e023881. doi: 10.1136/bmjopen-2018-023881.
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.
目的：基于一项随机试验的数据，从社会角度评估基于暴露的互联网认知行为疗法（internet-CBT）与候补对照相比，是否对患有肠易激综合征（IBS）的青少年来说是一种具有成本效益的治疗方法。
设计：试验内成本效益分析。
设置：参与者通过初级、二级和三级医疗机构从整个瑞典招募，这些医疗机构通过新闻媒体和广告进行接触。
参与者：被诊断患有 IBS 的青少年（年龄 13-17 岁）。
干预：参与者被随机分配到基于暴露的互联网-CBT 组，包括 10 个针对青少年的每周模块和 5 个针对父母的模块，或候补组。
主要结果：主要健康结果是通过映射儿科生活质量问卷（PedsQL）评分到 EQ-5D-3L 效用值来估计的质量调整生命年（QALY）。次要结果是 PedsQL 量表的点改善。在基线和治疗后 10 周收集健康结果和资源使用数据。使用 Trimbos 和医疗技术评估研究所精神科成本问卷（TIC-P）测量资源使用情况。增量成本效益比（ICER）计算为组间平均成本差异除以平均结果差异。
结果：基础案例结果表明，与候补组相比，互联网-CBT 组的参与者平均每人多花费 170.24 美元（95% CI 63.14 至 315.04）。互联网-CBT 组青少年的 QALY 增益较小（0.0031；95% CI 0.0003 至 0.0061），与候补组相比，PedsQL 的平均改善为 5.647 分（95% CI 1.82 至 9.46）。互联网-CBT 的 ICER 为 54916 美元/QALY 增加，在给定瑞典意愿支付阈值的情况下，具有 74%的成本效益概率。对于 PedsQL 结果，ICER 为 85.29 美元/分改善。
结论：为患有 IBS 的青少年提供互联网-CBT 可改善健康相关生活质量，并在等待对照组的基础上产生较小的 QALY 增益，但成本更高。鉴于强大的疗效证据、较小的 QALY 增益和较低的成本，互联网-CBT 可能具有成本效益。
试验注册号：NCT02306369；结果。
Clin Gastroenterol Hepatol. 2018-11-28
Cureus. 2023-12-23
J Med Internet Res. 2023-11-3
World J Clin Pediatr. 2023-1-9
Psychol Res Behav Manag. 2017-7-19
Neurogastroenterol Motil. 2017-4
Nat Rev Dis Primers. 2016-3-24
Clin Gastroenterol Hepatol. 2015-12-22
Zotero 插件