Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, YO10 5DD, York, UK.
Leeds and York Partnership NHS Foundation Trust, Leeds, UK.
BMC Psychiatry. 2022 Aug 12;22(1):547. doi: 10.1186/s12888-022-04192-8.
In the UK, around 93,000 (0.8%) children and young people (CYP) are experiencing specific phobias that have a substantial impact on daily life. The current gold-standard treatment-multi-session cognitive behavioural therapy (CBT) - is effective at reducing specific phobia severity; however, CBT is time consuming, requires specialist CBT therapists, and is often at great cost and limited availability. A briefer variant of CBT called one session treatment (OST) has been found to offer similar clinical effectiveness for specific phobia as multi-session CBT. The aim of this study was to assess the cost-effectiveness of OST compared to multi-session CBT for CYP with specific phobias through the Alleviating Specific Phobias Experienced by Children Trial (ASPECT), a two-arm, pragmatic, multi-centre, non-inferiority randomised controlled trial.
CYP aged seven to 16 years with specific phobias were recruited nationally via Health and Social Care pathways, remotely randomised to the intervention group (OST) or the control group (CBT-based therapies) and analysed (n = 267). Resource use based on NHS and personal social services perspective and quality adjusted life years (QALYs) measured by EQ-5D-Y were collected at baseline and at six-month follow-up. Incremental cost-effectiveness ratio (ICER) was calculated, and non-parametric bootstrapping was conducted to capture the uncertainty around the ICER estimates. The results were presented on a cost-effectiveness acceptability curve (CEAC). A set of sensitivity analyses (including taking a societal perspective) were conducted to assess the robustness of the primary findings.
After adjustment and bootstrapping, on average CYP in the OST group incurred less costs (incremental cost was -£302.96 (95% CI -£598.86 to -£28.61)) and maintained similar improvement in QALYs (QALYs gained 0.002 (95% CI - 0.004 to 0.008)). The CEAC shows that the probability of OST being cost-effective was over 95% across all the WTP thresholds. Results of a set of sensitivity analyses were consistent with the primary outcomes.
Compared to CBT, OST produced a reduction in costs and maintained similar improvement in QALYs. Results from both primary and sensitivity analyses suggested that OST was highly likely to be cost saving.
ISRCTN19883421 (30/11/2016).
在英国，约有 93000（0.8%）名儿童和青少年（CYP）患有对日常生活有重大影响的特定恐惧症。目前的黄金标准治疗方法——多疗程认知行为疗法（CBT）——在降低特定恐惧症严重程度方面是有效的；然而，CBT 耗时，需要专门的 CBT 治疗师，而且通常费用高昂且可用性有限。一种称为单次治疗（OST）的 CBT 变体已被发现对特定恐惧症的疗效与多疗程 CBT 相似。本研究旨在通过 Alleviating Specific Phobias Experienced by Children Trial（ASPECT）评估 OST 与多疗程 CBT 相比对患有特定恐惧症的 CYP 的成本效益，ASPECT 是一项两臂、实用、多中心、非劣效性随机对照试验。
通过健康和社会保健途径在全国范围内招募年龄在 7 至 16 岁之间患有特定恐惧症的 CYP，远程随机分配到干预组（OST）或对照组（基于 CBT 的治疗），并进行分析（n=267）。从 NHS 和个人社会服务的角度收集资源使用情况，并通过 EQ-5D-Y 测量质量调整生命年（QALYs）。在基线和 6 个月随访时收集数据。计算增量成本效果比（ICER），并进行非参数引导以捕获 ICER 估计值的不确定性。结果以成本效果接受曲线（CEAC）表示。进行了一系列敏感性分析（包括从社会角度考虑），以评估主要发现的稳健性。
调整和引导后，OST 组的 CYP 平均成本较低（增量成本为-£302.96（95%CI -£598.86 至 -£28.61）），同时 QALYs 保持相似的改善（QALYs 增加 0.002（95%CI -0.004 至 0.008））。CEAC 显示，在所有意愿支付阈值下，OST 具有成本效益的可能性均超过 95%。一组敏感性分析的结果与主要结果一致。
与 CBT 相比，OST 降低了成本，并保持了 QALYs 的相似改善。主要和敏感性分析的结果均表明，OST 极有可能节省成本。
ISRCTN83421（2016 年 11 月 30 日）。
