Cost and effectiveness of one session treatment (OST) for children and young people with specific phobias compared to multi-session cognitive behavioural therapy (CBT): results from a randomised controlled trial.
Adolescent
Child
Cognitive behavioural therapy
Cost
Cost-effectiveness
EQ-5D-Y
Mental health services
One session treatment
Phobic disorders
Journal
BMC psychiatry
ISSN: 1471-244X
Titre abrégé: BMC Psychiatry
Pays: England
ID NLM: 100968559
Informations de publication
Date de publication:
12 08 2022
12 08 2022
Historique:
received:
31
08
2021
accepted:
29
07
2022
entrez:
12
8
2022
pubmed:
13
8
2022
medline:
17
8
2022
Statut:
epublish
Résumé
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).
Sections du résumé
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
TRIAL REGISTRATION
ISRCTN19883421 (30/11/2016).
Identifiants
pubmed: 35962334
doi: 10.1186/s12888-022-04192-8
pii: 10.1186/s12888-022-04192-8
pmc: PMC9372970
doi:
Banques de données
ISRCTN
['ISRCTN19883421']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
547Subventions
Organisme : Department of Health
Pays : United Kingdom
Informations de copyright
© 2022. The Author(s).
Références
BMJ Open. 2016 Aug 11;6(8):e011748
pubmed: 27515756
Behav Ther. 2015 Mar;46(2):141-55
pubmed: 25645164
Stat Med. 2011 Feb 20;30(4):377-99
pubmed: 21225900
Value Health. 2016 Jul-Aug;19(5):558-66
pubmed: 27565273
Appl Health Econ Health Policy. 2011 May 1;9(3):157-69
pubmed: 21506622
BMJ. 1996 Jul 6;313(7048):36-9
pubmed: 8664772
J Consult Clin Psychol. 2009 Jun;77(3):504-16
pubmed: 19485591
Qual Life Res. 2009 Oct;18(8):1105-13
pubmed: 19693703
Health Technol Assess. 2017 Sep;21(50):1-58
pubmed: 28877841
Health Econ. 1997 Jul-Aug;6(4):327-40
pubmed: 9285227
BMJ Open. 2018 Aug 17;8(8):e025031
pubmed: 30121618
Cognit Ther Res. 2012 Oct 1;36(5):427-440
pubmed: 23459093
J Consult Clin Psychol. 2001 Oct;69(5):814-24
pubmed: 11680558
Clin Psychol Rev. 2011 Jun;31(4):592-602
pubmed: 21482318
Behav Res Ther. 1989;27(1):1-7
pubmed: 2914000
Clin Psychol Rev. 2006 Jan;26(1):17-31
pubmed: 16199119
J Behav Ther Exp Psychiatry. 2017 Mar;54:128-134
pubmed: 27474792
Health Econ. 2004 May;13(5):437-52
pubmed: 15127424
Med Care. 1997 Nov;35(11):1095-108
pubmed: 9366889
Annu Rev Clin Psychol. 2019 May 7;15:233-256
pubmed: 30550722
Cochrane Database Syst Rev. 2015 Feb 18;(2):CD004690
pubmed: 25692403
Qual Life Res. 2010 Aug;19(6):887-97
pubmed: 20401552
J Am Acad Child Adolesc Psychiatry. 2001 Aug;40(8):937-44
pubmed: 11501694
Cogn Behav Ther. 2013;42(4):275-83
pubmed: 23957749
Health Econ. 2005 May;14(5):487-96
pubmed: 15497198
Behav Ther. 2008 Sep;39(3):207-23
pubmed: 18721635
Br J Psychiatry. 2006 Jun;188:541-6
pubmed: 16738344
Health Econ. 2002 Jul;11(5):415-30
pubmed: 12112491
BMJ Open. 2014 Jul 09;4(7):e005952
pubmed: 25009139
Health Econ. 2004 May;13(5):405-15
pubmed: 15127421
Health Technol Assess. 2015 Feb;19(14):1-503, v-vi
pubmed: 25692211
J Child Psychol Psychiatry. 2022 Aug 1;:
pubmed: 35915056
Child Adolesc Psychiatr Clin N Am. 2011 Apr;20(2):217-38
pubmed: 21440852
J Clin Child Adolesc Psychol. 2008 Jan;37(1):105-30
pubmed: 18444055
BMJ Open. 2016 Apr 25;6(4):e009327
pubmed: 27113231
BMJ Open. 2022 Jan 17;12(1):e056347
pubmed: 35039300