Risør Bettina Wulff, Frydendal Ditte Hoffmann, Villemoes Marie Konge, Nielsen Camilla Palmhøj, Rask Charlotte Ulrikka, Frostholm Lisbeth
DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark.
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, University City 21 and 23, 8000, Aarhus C, Denmark.
Pharmacoecon Open. 2022 Mar;6(2):179-192. doi: 10.1007/s41669-021-00319-x. Epub 2022 Jan 8.
Health anxiety is a prevalent and debilitating disorder associated with extensive use of healthcare services and reduced quality of life (QoL). Regional variability in specialised clinics or specialist healthcare providers limits access to evidence-based treatment, which may be overcome by internet-delivered Acceptance and Commitment Therapy (iACT).
This study investigated the cost effectiveness of iACT for severe health anxiety in adults.
Based on a Danish randomised controlled trial (March 2016-March 2017), the economic evaluation compared costs and effects between iACT and an active control condition (iFORUM). Effectiveness was measured using self-report questionnaires. The cost analysis applied a societal perspective. Resource use and healthcare costs were extracted from the Danish National Registries. Linear regression analysis was applied using change in costs/effectiveness outcomes as the dependant variable. Time, group, and interaction between time and group were independent variables. The primary outcome was the proportion of clinically significant improvements, defined as a ≥ 25% reduction in two measures of health anxiety. The probability of cost effectiveness was presented in a cost-effectiveness acceptability curve for a range of threshold values for willingness to pay.
No significant differences were detected in healthcare costs between groups; however, the iACT group significantly improved in all effectiveness outcomes. The economic analysis showed that, from the healthcare perspective, iACT was associated with an incremental cost-effectiveness ratio of €33 per additional case of clinically significant improvement compared with iFORUM and that, from the societal perspective, iACT dominated iFORUM because it was more effective and less expensive.
We found no statistically significant differences in costs between groups; however, iACT for severe health anxiety may be cost effective, as evidenced by significant differences in effect.
Clinicaltrials.gov, no. NCT02735434.
健康焦虑是一种普遍且使人衰弱的疾病，与大量使用医疗服务以及生活质量（QoL）下降相关。专科诊所或专科医疗服务提供者的地区差异限制了获得循证治疗的机会，而基于互联网的接受与承诺疗法（iACT）可能会克服这一问题。
本研究调查了iACT治疗成人严重健康焦虑的成本效益。
基于一项丹麦随机对照试验（2016年3月至2017年3月），该经济评估比较了iACT与积极对照条件（iFORUM）之间的成本和效果。使用自我报告问卷测量有效性。成本分析采用社会视角。资源使用和医疗成本从丹麦国家登记处提取。使用成本/效果结果的变化作为因变量进行线性回归分析。时间、组以及时间与组之间的交互作用为自变量。主要结局是临床显著改善的比例，定义为两种健康焦虑测量指标降低≥25%。针对一系列支付意愿阈值，在成本效益可接受性曲线中呈现成本效益的概率。
两组之间在医疗成本方面未检测到显著差异；然而，iACT组在所有有效性结局方面均有显著改善。经济分析表明，从医疗保健角度来看，与iFORUM相比，iACT每增加一例临床显著改善的增量成本效益比为33欧元；从社会角度来看，iACT优于iFORUM，因为它更有效且成本更低。
我们发现两组之间在成本方面无统计学显著差异；然而，iACT治疗严重健康焦虑可能具有成本效益，效果上的显著差异证明了这一点。
Clinicaltrials.gov，编号NCT02735434。
