Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Institute of Cancer Research, Sutton, UK.
Psychooncology. 2021 Oct;30(10):1691-1698. doi: 10.1002/pon.5751. Epub 2021 Jun 27.
A previous equivalence randomised trial indicated that Telephone-based Cognitive Behaviour Therapy (T-CBT) was not inferior to Treatment as Usual CBT (TAU-CBT) delivered face to face in terms of psychological benefit with both groups showing post-therapy improvements compared to pre-therapy baseline. The aim here is to clarify costs and benefits through an economic evaluation of the two therapy models.
The cost-effectiveness analysis (cost per quality-adjusted life year [QALY]) was derived from a single-centre (UK-based), two-arm randomised control trial. Data from 78 patients were available for the main analysis, which includes both an NHS cost perspective and a societal perspective which includes the cost of time off work and any additional private care. Sensitivity analyses were undertaken, which included patients only completing the four core therapy sessions (46 patients) and considering only patients taking both core and the additional therapy sessions which were optional (32 patients).
The base-case analysis, adopting an NHS perspective, showed that T-CBT was associated with an incremental cost of £50 (95% CI: -£759 to £989) and a 0.03 QALY (95% CI: -0.09 to 0.03) decrement per patient when compared to TAU-CBT. The analysis adopting a societal perspective yielded similar results, with T-CBT providing an incremental cost of £171 (95% CI: -£769 to £1112) and a 0.03 QALY (95% CI: -0.08 to 0.03) decrement per patient in comparison to TAU-CBT. The first sensitivity analysis, considering patients only taking the core therapy sessions, showed that T-CBT provided an incremental cost of £100 (95% CI: -£945 to £1247) and yielded a decrement of 0.01 QALY (95% CI: -0.03 to 0.01) per patient compared to TAU-CBT. The second sensitivity analysis, which focused solely on patients who also underwent optional sessions, showed that T-CBT was associated with an incremental cost of £17 (95% CI: -£1307 to £1454) and a 0.04 QALY (95% CI: -0.11 to 0.03) decrement per patient when compared to TAU-CBT.
Based on this single trial, T-CBT is not cost-effective as a therapy option for cancer patients with high psychological needs when compared to TAU-CBT.
先前的等效随机试验表明，基于电话的认知行为疗法（T-CBT）在心理获益方面并不逊于面对面的常规治疗认知行为疗法（TAU-CBT），两组在治疗后均比治疗前基线有所改善。这里的目的是通过对两种治疗模式的经济评估来澄清成本和收益。
成本效益分析（每质量调整生命年的成本[QALY]）源自一项单中心（英国）、双臂随机对照试验。主要分析中可获得 78 名患者的数据，包括 NHS 成本视角和包括工作时间损失和任何额外私人护理费用的社会视角。进行了敏感性分析，包括仅完成四个核心治疗课程的患者（46 名患者）和仅考虑接受核心和可选附加治疗课程的患者（32 名患者）。
采用 NHS 视角的基本情况分析表明，与 TAU-CBT 相比，T-CBT 与每位患者 50 英镑（95%CI：-759 至 989 英镑）的增量成本和 0.03 QALY（95%CI：-0.09 至 0.03）的减损相关。采用社会视角的分析得出了类似的结果，与 TAU-CBT 相比，T-CBT 为每位患者提供了 171 英镑（95%CI：-769 至 1112 英镑）的增量成本和 0.03 QALY（95%CI：-0.08 至 0.03）的减损。第一次敏感性分析仅考虑接受核心治疗课程的患者，表明 T-CBT 提供了 100 英镑（95%CI：-945 至 1247 英镑）的增量成本，并导致每位患者 0.01 QALY（95%CI：-0.03 至 0.01）的减损与 TAU-CBT 相比。第二次敏感性分析仅关注也接受可选课程的患者，表明与 TAU-CBT 相比，T-CBT 与每位患者 17 英镑（95%CI：-1307 至 1454 英镑）的增量成本和 0.04 QALY（95%CI：-0.11 至 0.03）的减损相关。
基于这项单试验，与 TAU-CBT 相比，T-CBT 作为高心理需求癌症患者的治疗选择并不具有成本效益。
