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Acceptability, effectiveness and cost-effectiveness of blended cognitive-behavioural therapy (bCBT) versus face-to-face CBT (ftfCBT) for anxiety disorders in specialised mental health care: A 15-week randomised controlled trial with 1-year follow-up

Author

Listed:
  • Geke Romijn
  • Neeltje Batelaan
  • Jeroen Koning
  • Anton van Balkom
  • Aart de Leeuw
  • Friederike Benning
  • Leona Hakkaart van Roijen
  • Heleen Riper

Abstract

Background: Anxiety disorders are highly prevalent and cause substantial economic burden. Blended cognitive-behavioural therapy (bCBT), which integrates Internet-based CBT and face-to-face CBT (ftfCBT), is an attractive and potentially cost-saving treatment alternative to conventional CBT for patients with anxiety disorders in specialised mental health care. However, little is known about the effectiveness of bCBT in routine care. We examined the acceptability, effectiveness and cost-effectiveness of bCBT versus ftfCBT in outpatient specialised care to patients with panic disorder, social anxiety disorder and generalised anxiety disorder. Methods and findings: Patients with anxiety disorders were randomised to bCBT (n = 52) or ftfCBT (n = 62). Acceptability of bCBT and ftfCBT were evaluated by assessing treatment preference, adherence, satisfaction and therapeutic alliance. Costs and effects were assessed at post-treatment and one-year follow-up. Primary outcome measure was the Beck Anxiety Inventory (BAI). Secondary outcomes were depressive symptoms, general psychopathology, work and social adjustment, quality of life and mastery. Incremental cost-effectiveness ratios (ICERs) were computed from societal and healthcare perspectives by calculating the incremental costs per incremental quality-adjusted life year (QALY). No significant differences between bCBT and ftfCBT were found on acceptability or effectiveness measures at post-treatment (Cohen’s d between-group effect size on BAI = 0.15, 95% CI −0.30 to 0.60) or at one-year follow-up (d = −0.38, 95% CI −0.84 to 0.09). The modelled point estimates of societal costs (bCBT €10945, ftfCBT €10937) were higher and modelled point estimates of direct medical costs (bCBT €3748, ftfCBT €3841) were lower in bCBT. The acceptability curves showed that bCBT was expected to be a cost-effective intervention. Results should be carefully interpreted due to the small sample size. Conclusions: bCBT appears an acceptable, clinically effective and potentially cost-saving alternative option for treating patients with anxiety disorders. Trials with larger samples are needed to further investigate cost-effectiveness. Trial registration: Netherlands Trial Register: NTR4912.

Suggested Citation

  • Geke Romijn & Neeltje Batelaan & Jeroen Koning & Anton van Balkom & Aart de Leeuw & Friederike Benning & Leona Hakkaart van Roijen & Heleen Riper, 2021. "Acceptability, effectiveness and cost-effectiveness of blended cognitive-behavioural therapy (bCBT) versus face-to-face CBT (ftfCBT) for anxiety disorders in specialised mental health care: A 15-week ," PLOS ONE, Public Library of Science, vol. 16(11), pages 1-20, November.
    • Handle: RePEc:plo:pone00:0259493
    DOI: 10.1371/journal.pone.0259493
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    References listed on IDEAS

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    1. Glick, Henry A. & Doshi, Jalpa A. & Sonnad, Seema S. & Polsky, Daniel, 2014. "Economic Evaluation in Clinical Trials," OUP Catalogue, Oxford University Press, edition 2, number 9780199685028, Decembrie.
    2. Marieke Krol & Jocé Papenburg & Marc Koopmanschap & Werner Brouwer, 2011. "Do Productivity Costs Matter?," PharmacoEconomics, Springer, vol. 29(7), pages 601-619, July.
    3. Rita Faria & Manuel Gomes & David Epstein & Ian White, 2014. "A Guide to Handling Missing Data in Cost-Effectiveness Analysis Conducted Within Randomised Controlled Trials," PharmacoEconomics, Springer, vol. 32(12), pages 1157-1170, December.
    4. Janet MacNeil Vroomen & Iris Eekhout & Marcel G. Dijkgraaf & Hein van Hout & Sophia E. de Rooij & Martijn W. Heymans & Judith E. Bosmans, 2016. "Multiple imputation strategies for zero-inflated cost data in economic evaluations: which method works best?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(8), pages 939-950, November.
    5. Koopmanschap, Marc A. & Rutten, Frans F. H. & van Ineveld, B. Martin & van Roijen, Leona, 1995. "The friction cost method for measuring indirect costs of disease," Journal of Health Economics, Elsevier, vol. 14(2), pages 171-189, June.
    6. Henry Glick, 2011. "Sample Size and Power for Cost-Effectiveness Analysis (Part 1)," PharmacoEconomics, Springer, vol. 29(3), pages 189-198, March.
    7. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629, Decembrie.
    8. De Brey, Henk, 1983. "A cross-national validation of the Client Satisfaction Questionnaire: The Dutch experience," Evaluation and Program Planning, Elsevier, vol. 6(3-4), pages 395-400, January.
    9. William C. Black, 1990. "The CE Plane," Medical Decision Making, , vol. 10(3), pages 212-214, August.
    10. Jeff Richardson & Angelo Iezzi & Munir Khan & Aimee Maxwell, 2014. "Validity and Reliability of the Assessment of Quality of Life (AQoL)-8D Multi-Attribute Utility Instrument," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 7(1), pages 85-96, March.
    11. Henry Glick, 2011. "Sample Size and Power for Cost-Effectiveness Analysis (Part 2)," PharmacoEconomics, Springer, vol. 29(4), pages 287-296, April.
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