Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65, Stockholm, Sweden.
School of Law, Psychology and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden.
BMC Gastroenterol. 2021 Jul 13;21(1):289. doi: 10.1186/s12876-021-01867-6.
Irritable bowel syndrome (IBS) is a debilitating and costly disorder. Cognitive behavior therapy (CBT) is effective in the treatment of IBS, both when delivered over the internet and in face-to-face settings. CBT consists of different components and little is known about their relative importance. We have in an earlier study showed that inclusion of exposure in the CBT for IBS makes it even more effective. In the present study we wanted to evaluate the economic effects for society of inclusion vs exclusion of exposure in an internet delivered CBT for IBS.
We used data from a previous study with 309 participants with IBS. Participants were randomized to internet delivered CBT with (ICBT) or without exposure (ICBT-WE). We compared direct and indirect costs at baseline, after treatment, and 6 months after treatment (primary endpoint; 6MFU). Data was also collected on symptom severity and time spent by therapists and participants. The relative Incremental Cost Effectiveness Ratio (ICER) was calculated for the two treatment conditions and the return on investment (ROI).
Results showed that ICBT cost $213.5 (20%) more than ICBT-WE per participant. However, ICBT was associated with larger reductions regarding both costs and symptoms than ICBT-WE at 6MFU. The ICER was - 301.69, meaning that for every point improvement on the Gastrointestinal Symptom Rating Scale-IBS version in ICBT, societal costs would be reduced with approximately $300. At a willingness to pay for a case of clinically significant improvement in IBS symptoms of $0, there was an 84% probability of cost-effectiveness. ROI analysis showed that for every $1 invested in ICBT rather than ICBT-WE, the return would be $5.64 six months after treatment. Analyses of post-treatment data showed a similar pattern although cost-savings were smaller.
Including exposure in Cognitive Behavior Treatment for IBS is more cost-effective from a societal perspective than not including it, even though it may demand more therapist and patient time in the short term.
This study is reported in accordance with the CONSORT statement for non-pharmacological trials [1]. Clinicaltrials.gov registration ID: NCT01529567 (14/02/2013).
肠易激综合征（IBS）是一种使人虚弱且代价高昂的疾病。认知行为疗法（CBT）在治疗 IBS 方面非常有效，无论是通过互联网还是面对面的方式进行。CBT 由不同的组成部分组成，其相对重要性知之甚少。我们之前的一项研究表明，在 IBS 的 CBT 中加入暴露疗法会使其更有效。在本研究中，我们想评估在互联网上提供的 CBT 中纳入与排除暴露疗法对社会的经济影响。
我们使用了一项针对 309 名 IBS 患者的先前研究的数据。参与者被随机分配到接受互联网提供的 CBT（ICBT）或不接受暴露疗法的 CBT（ICBT-WE）。我们比较了基线、治疗后和治疗后 6 个月（主要终点；6MFU）的直接和间接成本。还收集了症状严重程度和治疗师和参与者花费的时间的数据。计算了两种治疗条件的相对增量成本效益比（ICER）和投资回报率（ROI）。
结果表明，每位参与者的 ICBT 费用比 ICBT-WE 高 213.5 美元（20%）。然而，ICBT 在 6MFU 时与 ICBT-WE 相比，与成本和症状的更大降低相关。ICER 为-301.69，这意味着在胃肠道症状评定量表-IBS 版本上每提高一个点，社会成本将降低约 300 美元。在愿意为 IBS 症状的临床显著改善支付 0 美元的情况下，成本效益的可能性为 84%。ROI 分析表明，在治疗后数据的分析中，投资于 ICBT 而不是 ICBT-WE 的每 1 美元，在治疗后 6 个月的回报率将为 5.64 美元。尽管短期来看可能需要更多的治疗师和患者时间，但从社会角度来看，将暴露疗法纳入 IBS 的认知行为治疗更具成本效益。
从社会角度来看，在 IBS 的认知行为治疗中纳入暴露疗法比不纳入更具成本效益，尽管这可能需要在短期内投入更多的治疗师和患者时间。
本研究按照非药物试验的 CONSORT 声明进行报告[1]。Clinicaltrials.gov 注册号：NCT01529567（2013 年 2 月 14 日）。
