Cost-effectiveness of internet-delivered cognitive-behavioural therapy for adolescents with irritable bowel syndrome

Filipa Sampaio, Marianne Bonnert, Ola Olén, Erik Hedman, Maria Lalouni, Fabian Lenhard, Brjánn Ljótsson, Richard Ssegonja, Eva Serlachius, Inna Feldman, Filipa Sampaio, Marianne Bonnert, Ola Olén, Erik Hedman, Maria Lalouni, Fabian Lenhard, Brjánn Ljótsson, Richard Ssegonja, Eva Serlachius, Inna Feldman

Abstract

Objective: To assess whether exposure-based internet-delivered cognitive-behavioural therapy (internet-CBT) is a cost-effective treatment for adolescents with irritable bowel syndrome (IBS) compared with a waitlist control, from a societal perspective, based on data from a randomised trial.

Design: Within-trial cost-effectiveness analysis.

Setting: Participants were recruited from the whole of Sweden via primary, secondary and tertiary care clinics reached through news media and advertising.

Participants: Adolescents (aged 13-17) with a diagnosis of IBS.

Interventions: Participants were randomised to either an exposure-based internet-CBT, including 10 weekly modules for adolescents and five modules for parents, or a waitlist.

Outcome measures: The main health outcome was the quality-adjusted life-year (QALY) estimated by mapping Pediatric Quality-of-Life Inventory (PedsQL) scores onto EQ-5D-3L utilities. The secondary outcome was the point improvement on the PedsQL scale. Data on health outcomes and resource use were collected at baseline and 10 weeks post-treatment. Resource use was measured using the Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry (TIC-P) . Incremental cost-effectiveness ratios (ICER) were calculated as the difference in average costs by the difference in average outcomes between groups.

Results: The base-case results showed that internet-CBT costs were on average US$170.24 (95% CI 63.14 to 315.04) more per participant than the waitlist. Adolescents in the internet-CBT group showed small QALY gains (0.0031; 95% CI 0.0003 to 0.0061), and an average improvement of 5.647 points (95% CI 1.82 to 9.46) on the PedsQL compared with the waitlist. Internet-CBT yielded an ICER of $54 916/QALY gained and a probability of cost-effectiveness of 74% given the Swedish willingness-to-pay threshold. The ICER for the outcome PedsQL was US$85.29/point improvement.

Conclusions: Offering internet-CBT to adolescents with IBS improves health-related quality of life and generates small QALY gains at a higher cost than a waitlist control. Internet-CBT is thus likely to be cost-effective given the strong efficacy evidence, small QALY gains and low cost.

Trial registration number: NCT02306369; Results.

Keywords: adolescents; cognitive-behaviour therapy; cost-effectiveness; irritable bowel syndrome.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Cost-effectiveness plane of the differences in mean costs and differences in mean quality-adjusted life-years (QALY) between exposure-based internet-delivered cognitive–behavioural therapy (internet-CBT) and the waitlist.
Figure 2
Figure 2
Cost-effectiveness acceptability curve showing the probability that exposure-based internet-delivered cognitive–behavioural therapy (internet-CBT) is cost-effective for different willingness-to-pay values. QALY, quality-adjusted life-year.

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