Tie Hiong, Krebs Georgina, Lang Katie, Shearer James, Turner Cynthia, Mataix-Cols David, Lovell Karina, Heyman Isobel, Byford Sarah
Research Worker,Health Service and Population Research Department,Institute of Psychiatry, Psychology and Neuroscience at King's College London,UK.
Clinical Research Training Fellow,Social, Genetic and Developmental Psychiatry Centre Institute of Psychiatry, Psychology and Neuroscience at King's College London,UK.
BJPsych Open. 2019 Jan;5(1):e7. doi: 10.1192/bjo.2018.73.
Telephone cognitive-behaviour therapy (TCBT) may be a cost-effective method for improving access to evidence-based treatment for obsessive-compulsive disorder (OCD) in young people.AimsEconomic evaluation of TCBT compared with face-to-face CBT for OCD in young people.
Randomised non-inferiority trial comparing TCBT with face-to-face CBT for 72 young people (aged 11 to 18) with a diagnosis of OCD. Cost-effectiveness at 12-month follow-up was explored in terms of the primary clinical outcome (Children's Yale-Brown Obsessive-Compulsive Scale, CY-BOCS) and quality-adjusted life-years (QALYs) (trial registration: ISRCTN27070832).
Total health and social care costs were higher for face-to-face CBT (mean total cost £2965, s.d. = £1548) than TCBT (mean total cost £2475, s.d. = £1024) but this difference was non-significant (P = 0.118). There were no significant between-group differences in QALYs or the CY-BOCS and there was strong evidence to support the clinical non-inferiority of TCBT. Cost-effectiveness analysis suggests a 74% probability that face-to-face CBT is cost-effective compared with TCBT in terms of QALYs, but the result was less clear in terms of CY-BOCS, with TCBT being the preferred option at low levels of willingness to pay and the probability of either intervention being cost-effective at higher levels of willingness to pay being around 50%.
Although cost-effectiveness of TCBT was sensitive to the outcome measure used, TCBT should be considered a clinically non-inferior alternative when access to standard clinic-based CBT is limited, or when patient preference is expressed.Declaration of interestD.M.-C. reports research grants from the Swedish Research Council (Vetenskapsrådet), the Swedish Research Council for Health, working life and welfare (Forte), the US National Institute of Mental Health (NIMH), the UK National Institute of Health Research (NIHR), as well as royalties from Wolters Kluwer Health and Elsevier, all unrelated to the submitted work.
电话认知行为疗法（TCBT）可能是一种经济有效的方法，有助于改善年轻人强迫症（OCD）患者获得循证治疗的机会。
对年轻人强迫症患者的TCBT与面对面认知行为疗法（CBT）进行经济学评估。
一项随机非劣效性试验，将72名诊断为强迫症的11至18岁年轻人分为TCBT组和面对面CBT组。根据主要临床结局（儿童耶鲁-布朗强迫症量表，CY-BOCS）和质量调整生命年（QALYs）探讨12个月随访时的成本效益（试验注册号：ISRCTN27070832）。
面对面CBT的总健康和社会护理成本（平均总成本2965英镑，标准差=1548英镑）高于TCBT（平均总成本2475英镑，标准差=1024英镑），但这种差异不显著（P=0.118）。两组在QALYs或CY-BOCS方面无显著差异，有强有力的证据支持TCBT的临床非劣效性。成本效益分析表明，就QALYs而言，面对面CBT比TCBT具有成本效益的概率为74%，但就CY-BOCS而言结果不太明确，在支付意愿较低时TCBT是首选方案，在支付意愿较高时两种干预措施具有成本效益的概率约为50%。
尽管TCBT的成本效益对所使用的结局指标敏感，但当获得基于标准诊所的CBT有限或患者表达了偏好时，TCBT应被视为临床上非劣效的替代方案。
D.M.-C.报告从瑞典研究理事会（Vetenskapsrådet）、瑞典卫生、工作生活和福利研究理事会（Forte）、美国国立精神卫生研究所（NIMH）、英国国立卫生研究院（NIHR）获得研究资助，以及从Wolters Kluwer Health和Elsevier获得版税，所有这些均与提交的工作无关。
