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Cost-effectiveness of transdiagnostic group cognitive behavioural therapy for anxiety disorders v. treatment as usual: economic evaluation of a pragmatic randomized controlled trial over an 8-month time horizon using self-reported data

Published online by Cambridge University Press:  25 January 2023

Alexandra Chapdelaine Open the ORCID record for Alexandra Chapdelaine [Opens in a new window] ,
Helen-Maria Vasiliadis Open the ORCID record for Helen-Maria Vasiliadis [Opens in a new window] ,
Martin D. Provencher Open the ORCID record for Martin D. Provencher [Opens in a new window] ,
Peter J. Norton Open the ORCID record for Peter J. Norton [Opens in a new window]  and
Pasquale Roberge Open the ORCID record for Pasquale Roberge [Opens in a new window]
Alexandra Chapdelaine
Affiliation:
PRIMUS Research Group, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, local Z7-3004, Sherbrooke, Québec, J1H 5N4, Canada
Helen-Maria Vasiliadis
Affiliation:
Université de Sherbrooke – Campus de Longueuil, Charles-Le Moyne Research Center, 150 Place Charles Lemoyne, Longueuil, Québec, J4K 0A8, Canada
Martin D. Provencher
Affiliation:
École de psychologie, Pavillon Félix-Antoine-Savard, 2325, rue des Bibliothèques, Université Laval, Québec, Québec, G1V 0A6, Canada
Peter J. Norton
Affiliation:
The Cairnmillar Institute, 391-393 Tooronga Rd, Hawthorn East, Victoria 3123, Australia
Pasquale Roberge*
Affiliation:
Department of family medicine and emergency medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, local Z7-3004, Sherbrooke, Québec, J1H 5N4, Canada
*
Author for correspondence: Pasquale Roberge, E-mail: Pasquale.Roberge@usherbrooke.ca
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Abstract

Background

This economic evaluation supplements a pragmatic randomized controlled trial conducted in community care settings, which showed superior improvement in the symptoms of adults with anxiety disorders who received 12 sessions of transdiagnostic cognitive-behavioural group therapy in addition to treatment as usual (tCBT + TAU) compared to TAU alone.

Methods

This study evaluates the cost-utility and cost-effectiveness of tCBT + TAU over an 8-month time horizon. For the reference case, quality-adjusted life years (QALYs) obtained using the EQ-5D-5L, and the health system perspective were chosen. Alternatively, anxiety-free days (AFDs), derived from the Beck Anxiety Inventory, and the limited societal perspective were considered. Unadjusted incremental cost-effectiveness/utility ratios were calculated. Net-benefit regressions were done for a willingness-to-pay (WTP) thresholds range to build cost-effectiveness acceptability curves (CEAC). Sensitivity analyses were included.

Results

Compared to TAU (n = 114), tCBT + TAU (n = 117) generated additional QALYs, AFDs, and higher mental health care costs from the health system perspective. From the health system and the limited societal perspectives, at a WTP of Can$ 50 000/QALY, the CEACs showed that the probability of tCBT + TAU v. TAU being cost-effective was 97 and 89%. Promising cost-effectiveness results using AFDs are also presented. The participation of therapists from the public health sector could increase cost-effectiveness.

Conclusions

From the limited societal and health system perspectives, this first economic evaluation of tCBT shows favourable cost-effectiveness results at a WTP threshold of Can$ 50 000/QALY. Future research is needed to replicate findings in longer follow-up studies and different health system contexts to better inform decision-makers for a full-scale implementation.

Keywords

Anxiety disorderscognitive behaviour therapygroup psychotherapyhealth care economicstransdiagnostic
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 14 , October 2023 , pp. 6570 - 6582
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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