Cost effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome: the ACTIB randomised trial

Background Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiven...

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Published in:BMC gastroenterology 2021-07, Vol.21 (1), p.1-276, Article 276
Main Authors: McCrone, Paul, Everitt, Hazel, Landau, Sabine, Little, Paul, Bishop, Felicity L, O'Reilly, Gilly, Sibelli, Alice, Holland, Rachel, Hughes, Stephanie, Windgassen, Sula, Goldsmith, Kim, Coleman, Nicholas, Logan, Robert, Chalder, Trudie, Moss-Morris, Rona
Format: Article
Language:English
Subjects:
Acupuncture
Behavior modification
Care and treatment
Cognitive ability
Cognitive behavioral therapy
Cognitive behavioural therapy
Cognitive therapy
Comparative analysis
Cost analysis
Cost-effectiveness
Economic evaluation
Gastroenterology
Health services
Intervention
Irritable bowel syndrome
Methods
Patient outcomes
Quality of life
Self-care, Health
Therapists
Therapy
Wage rates
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Summary:Background Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiveness of the interventions. Methods Participants were recruited from 74 general practices and three gastroenterology centres in England. Interventions costs were calculated, and other service use and lost employment measured and costed for one-year post randomisation. Quality-adjusted life years (QALYs) were combined with costs to determine cost-effectiveness of TCBT and WCBT compared to TAU. Results TCBT cost [pounds sterling]956 more than TAU (95% CI, [pounds sterling]601-[pounds sterling]1435) and generated 0.0429 more QALYs. WCBT cost [pounds sterling]224 more than TAU (95% CI, - [pounds sterling]11 to [pounds sterling]448) and produced 0.029 more QALYs. Compared to TAU, TCBT had an incremental cost per QALY of [pounds sterling]22,284 while the figure for WCBT was [pounds sterling]7724. After multiple imputation these ratios increased to [pounds sterling]27,436 and [pounds sterling]17,388 respectively. Including lost employment and informal care, TCBT had costs that were on average [pounds sterling]866 lower than TAU (95% CI, - [pounds sterling]1133 to [pounds sterling]2957), and WCBT had costs that were [pounds sterling]1028 lower than TAU (95% CI, - [pounds sterling]448 to [pounds sterling]2580). Conclusions TCBT and WCBT resulted in more QALYs and higher costs than TAU. Complete case analysis suggests both therapies are cost-effective from a healthcare perspective. Imputation for missing data reduces cost-effectiveness but WCTB remained cost-effective. If the reduced societal costs are included both interventions are likely to be more cost-effective. Trial registration ISRCTN44427879 (registered 18.11.13). Keywords: Irritable bowel syndrome, Cognitive behavioural therapy, Economic evaluation, Cost-effectiveness
ISSN:1471-230X
1471-230X
DOI:10.1186/s12876-021-01848-9