Department of Health Sciences, University of York, Heslington, York, England, UK.
Department of Health Sciences, University of York, Heslington, York, England, UK.
Value Health. 2020 Dec;23(12):1662-1670. doi: 10.1016/j.jval.2020.07.008. Epub 2020 Sep 24.
Cognitive behavioral therapy (CBT) is an effective treatment for depression. Different CBT delivery formats (face-to-face [F2F], multimedia, and hybrid) and intensities have been used to expand access to the treatment. The aim of this study is to estimate the long-term cost-effectiveness of different CBT delivery modes.
A decision-analytic model was developed to evaluate the cost-effectiveness of different CBT delivery modes and variations in intensity in comparison with treatment as usual (TAU). The model covered an average treatment period of 4 months with a 5-year follow-up period. The model was populated using a systematic review of randomized controlled trials and various sources from the literature.
Incremental cost-effectiveness ratios of treatments compared with the next best option after excluding all the dominated and extended dominated options are: £209/quality-adjusted life year (QALY) for 6 (sessions) × 30 (minutes) F2F-CBT versus TAU; £4 453/QALY for 8 × 30 F2F versus 6 × 30 F2F; £12 216/QALY for 8 × 60 F2F versus 8 × 30 F2F; and £43 072/QALY for 16 × 60 F2F versus 8 × 60 F2F. The treatment with the highest net monetary benefit for thresholds of £20 000 to £30 000/QALY was 8 × 30 F2F-CBT. Probabilistic sensitivity analysis illustrated 6 × 30 F2F-CBT had the highest probability (32.8%) of being cost-effective at £20 000/QALY; 16 × 60 F2F-CBT had the highest probability (31.0%) at £30 000/QALY.
All CBT delivery modes on top of TAU were found to be more cost-effective than TAU alone. Four F2F-CBT options (6 × 30, 8 × 30, 8 × 60, 16 × 60) are on the cost-effectiveness frontier. F2F-CBT with intensities of 6 × 30 and 16 × 60 had the highest probabilities of being cost-effective. The results, however, should be interpreted with caution owing to the high level of uncertainty.
认知行为疗法(CBT)是一种有效的抑郁症治疗方法。为了扩大治疗的可及性,已经使用了不同的 CBT 交付形式(面对面[F2F]、多媒体和混合)和强度。本研究的目的是估计不同 CBT 交付模式的长期成本效益。
开发了一个决策分析模型,以评估不同 CBT 交付模式和强度变化与常规治疗(TAU)相比的成本效益。该模型涵盖了 4 个月的平均治疗期和 5 年的随访期。该模型使用系统评价随机对照试验和文献中的各种来源进行填充。
与排除所有占主导地位和扩展主导地位的选择后下一个最佳选择相比,治疗的增量成本效益比为:6(次)×30(分钟)面对面 CBT 与 TAU 相比为 209 英镑/质量调整生命年(QALY);8×30 面对面 CBT 与 6×30 面对面 CBT 相比为 4453 英镑/QALY;8×60 面对面 CBT 与 8×30 面对面 CBT 相比为 12216 英镑/QALY;16×60 面对面 CBT 与 8×60 面对面 CBT 相比为 43072 英镑/QALY。对于 20000 英镑至 30000 英镑/QALY 的阈值,净货币收益最高的治疗方法是 8×30 面对面 CBT。概率敏感性分析表明,6×30 面对面 CBT 在 20000 英镑/QALY 时最有可能具有成本效益(32.8%);16×60 面对面 CBT 在 30000 英镑/QALY 时最有可能具有成本效益(31.0%)。
与 TAU 相比,TAU 之上的所有 CBT 交付模式都被发现更具成本效益。四种 F2F-CBT 选择(6×30、8×30、8×60、16×60)处于成本效益边界。6×30 和 16×60 强度的 F2F-CBT 具有最高的成本效益概率。然而,由于高度不确定性,结果应谨慎解释。