| Kumar et al, 2018,63 United States |
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Adults with GAD with or without comorbidities (GAD-7 scores: 5–9 (mild), 10–14 (moderate), 15–21 (severe) Mean age (overall): NR Female (overall): NR Modeled: Markov model, 3-mo cycle length, 8 health states (no anxiety, mild, moderate/severe anxiety without/with comorbidities [4 separate states], death); health state utilities linearly extrapolated from SF-6D scores elicited in adults with GAD, non-specific to CBT; extrapolation of 3-mo treatment effects over 5 yr, assuming a gradual decrease of the lifetime; risk of suicide independent of treatments associated with major depression, based on literature and modeled in the states combined with comorbidities
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Intervention: coach-guided iCBT, “Lantern”: 1) prevention (all patients starting with mild anxiety (GAD-7: 5–9); 2) treatment (patients starting with moderate or severe anxiety, GAD-7: >10–21), 3) both prevention and treatment Comparators: 1) TAU: pharmacotherapy (58.6% of the cohort) or nothing; 2) face-to-face CBT (12–20 1-hr sessions) iCBT: 3-mo program with 8 CBT modules accessible over the mobile application, support provided by a trained coach via asynchronous messages; pilot test included 89 employees; iCBT program assumed equivalent to face-to-face CBT
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Total QALYs (per 100,000), iCBT vs. face-to-face CBT vs. TAU: NR Mean difference, iCBT vs. face-to-face CBT/iCBT vs. TAU for 3 scenarios: 1) base case (both): 34,108/81,492 QALYs; 2) prevention only: 28,959/76,568 QALYs; 3) treatment only: 36,564/83,841 QALYs
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Currency: USD Year: 2016 Total costs (mean per 100,000, in billion $), iCBT vs. face-to-face CBT vs. TAU: 1) payer perspective, both/prevention/treatm ent: 24.9 vs. 25.3 vs. 25.5/24.9 vs. 25.2 vs. 25.4/24.9 vs. 25.3 vs. 25.6; 2) societal perspective, both/prevention/treatm ent: 36.5 vs. 38.7 vs. 41.0/36.3 vs. 38.2 vs. 40.4/36.6 vs. 38.9 vs. 41.3 Mean difference (per 100,000, in billion $), iCBT vs. face-to-face CBT, and iCBT vs. TAU: 1) payer perspective, both/prevention/treatm ent: a) 339/297/360; b) 605/553/630; 2) societal perspective, both/prevention/treatm ent: a) 339/297/360; b) 605/553/630
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Base-case analysis, iCBT compared with face-to-face CBT or TAU (pharmacotherapy alone), payer or societal perspective: cost saving (higher benefits, lower costs) Sensitivity analysis: PSA not conducted; a single deterministic sensitivity analysis showed that face-to-face CBT became as cost-effective as iCBT when clinical response rate in face-to-face CBT increased to 76% (from 42% in base case analysis), while cost-effectiveness remained the same for iCBT (38%)
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| El Alaoui et al, 2017,61 Sweden |
Individual-level cost-minimisation analysis, continues previous RCT by Hedman et al (2014) Noninferiority RCT, 4-yr follow-up Health care payer perspective Time horizon: 15 wk (treatment cycle) Discount rate: 0%, 3%, 5%
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Intervention: guided iCBT modules including homework exercises (n = 64) Comparator: face-to-face group CBT (n = 62) iCBT: online modules, 15 wk, with access to a therapist and supportive email feedback (time spent with a patient: 10 min/wk) Group iCBT: 15 sessions, 1 individual and 14 weekly group CBT sessions, 2.5 hr long, groups of 5–7 patients, led by CBT-trained therapists
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Currency: € Year: 2017 Total costs and resource use (mean), iCBT vs. group CBT, 80% capacity (base case): 463 (446–480) vs. 806 (730–883) Mean difference, at 80% capacity: −343 (–267 to −420) Resource use estimated using a bottom-up approach, costing clinical and administrative activities during the treatment delivery cycle
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Base-case analysis, the cost-minimization analysis, at 80%, 50%, or 100% capacity: iCBT cost saving in all analyses
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| Hedman et al, 2016,60 Sweden |
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Adults with severe lasting health anxiety (hypochondriasis), primary care setting (N = 158) Mean age, iCBT vs. control: 41.7 (SD: 13.6) vs. 41.4 (SD: 13.2) yr Females, iCBT vs. control: 81% vs. 77% Anxiety present for around 13 yr
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Intervention: iCBT modules including homework exercises (n = 79) Comparator: Control internet delivered behavioural stress management program (n = 79) iCBT: 12 modules over 12 wk, with access to a therapist via a secure online contact system
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Currency: USD Year: 2013 Total costs (mean), iCBT vs. control, post-treatment: 1,607 (SD: 1,698) vs. 1,340 (SD:1,123) Mean difference: 310 Cost of treatment: 571 vs. 431
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ICER of base-case analysis: $10,000 per QALY Probability of iCBT being cost-effective compared with control at a wtp per QALY: NR
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| Dear et al, 2015,62 Australia |
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Adults aged 60 yr or older with anxiety (GAD-7 ≥8), residents of Australia (N = 72) Mean age, intervention vs. control: 65.4 (SD: 4.7) vs. 65.5 (SD: 5.8) yr Females, intervention vs. control: 67% vs. 54% With previous mental health treatment, intervention vs. control: 54% vs. 49%; taking medications: 24% vs. 38%
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Intervention: supported iCBT program “Managing Stress and Anxiety Course” (n = 75) Comparator: TAU: Usual GP care (n = 64) iCBT supported by a clinical psychologist via email or phone on weekly basis; iCBT consisted of 5 lessons delivered over 8 wk Outcomes: QALYs and costs; iCBT costs included therapist's time, supervisors's time (1-hr supervision weekly), internet access, computer and telephone use but not cost of software; other health care resource use: medications, GP and psychiatric consultations, and admissions
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Total QALYs (mean per person), iCBT vs. control: 0.102 (0.044–0.139) vs. 0.092 (0.033–0.128) Mean difference: 0.01 (0.003–0.018)
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Currency: USD Year: 2013 Total costs (mean), iCBT vs. control: 229.5 (184.9–276.4) vs. 137.4 (98.4–173.5) Mean difference: 92.2 (38.7–149.2) Costs of guided iCBT associated per patient: £42
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ICER for base-case analysis: $8,806 per QALY Probability of iCBT being cost-effective compared with control at wtp of $50,000 per QALY: >95%
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| Nordgren et al, 2014,56 Sweden |
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Adults with an anxiety disorder by DSM-IV with or without comorbid problems, primary care setting (N = 100) Mean age, iCBT vs. control: 35 (SD:13) vs. 36 (SD:12) yr Females, iCBT vs. control: 33% vs. 30% Prior psychotherapy: 66%–68%, ongoing medication: 24%–28%, most commonly diagnosed with GAD or panic disorder (64%), 56%–60% with any comorbidity
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Intervention: guided iCBT, individually tailored (n = 50) Comparator: TAU for 10 wk, allowed cross-over after 10 wk (n =50) iCBT: 10 modules with homework, delivered weekly over 10 wk, supported by a therapist via internet messenger system, support provided within 24 hr and feedback on homework (≤15 min/wk per client), cost per client: $507 TAU: weekly email from a therapist related to well-being, no specific feedback (unless the therapist judged the further action was required), cost per client: $68
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Currency: USD Year: NR Total costs (mean), iCBT vs. control, pretreatment/post-treatment: $2,648 (SD: 1,812)/$1,757 (SD: 1,870) vs. $1,803 (SD:1,694)/$2,078 (SD:1,868) Mean difference: −$474 Significant time-group interaction: iCBT group had larger indirect cost reduction vs. control
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Base-case analysis, iCBT vs. TAU, ICER: −$7,523 per QALY; cost saving and more effective Probability of iCBT being cost-effective compared with control at wtp of $0 per QALY was 90%, rising above 95% at $3,000/QALY Sensitivity analysis: if iCBT increased by $600, probability of iCBT being cost-effective compared with control at wtp of $0 per QALY was 37% and was 60% at $3,500/QALY
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| Hedman et al, 2014,59 Sweden |
Individual-level cost-effectiveness and cost–utility analysis Noninferiority parallel-group RCT, 4-yr follow-up Societal perspective Time horizon: 4 yr (mean: 4.2, range: 3.1–5.3 yr) Discount rate: NR (0%)
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Adults with SAD (N = 126) Mean age, iCBT vs. group CBT: 35.2 (SD:11.2) vs. 35.5 (SD: 11.6) yr Females, iCBT vs. control: 37.5% vs. 33.9% Anxiety present for around 20 yr, 16% with comorbid major depression; 34% of patients in iCBT and 38% of patients in group CBT received additional treatment (CBT, psychological treatment, or medication) after finalizing the intervention in year 1
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Intervention: guided iCBT modules including homework exercises (n = 64) Comparator: face-to-face group CBT (n = 62) iCBT: online modules, 15 wk, with access to a therapist (psychologist) and supportive email feedback via text-based messaging system with no phone/face-to-face contact; on average 9 of 15 modules completed, cost per treated patient: $464 Group iCBT: 15 sessions, 1 individual and 14 weekly group CBT sessions including homework between sessions, 2.5 hr long, groups of 6–7 patients, led by CBT-trained experienced psychotherapists; on average 9 of 15 sessions completed, cost per treated patient: $2,687
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Total QALYs (mean), iCBT vs. group CBT, within group before intervention to 4-yr follow-up: −0.36 (–0.70 to −0.01) vs. −0.25 (–0.60 to 0.10) Mean difference, iCBT vs. group CBT: 0.11 Total QALYs (mean), iCBT vs. group CBT, between group before 4-yr follow-up: −0.18 (–0.53 to 0.17) No significant interaction of group and time
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Currency: USD Year: NR Total costs (mean), iCBT vs. group CBT, before and at 4-yr follow-up: before treatment, 14,096 (SD: 14,952) vs. 15,546 (SD: 15,852); after 4 yr, 6,349 (SD: 8,366) vs. 8,532 (SD: 7,464) Mean difference: −808
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Base-case analysis, iCBT vs. group CBT, ICER: −$7,345 per QALY; cost saving and more effective Probability of iCBT being cost-effective compared with group CBT at wtp of $0 per QALY is 62% and at wtp of $100,000 per QALY is 64%
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| Hedman et al, 2013,57 Sweden |
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Adults with severe lasting health anxiety and no history of psychosis/bipolar disorder (N = 81) Mean age, iCBT vs. control: 39.3 (SD:9.8) vs. 38.8 (SD: 9.5) yr Females, iCBT vs. control: 70% vs. 78% Anxiety present for around 20 yr
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Intervention: iCBT modules including homework exercises (n = 40) Comparator: Online discussion forum (n = 41) iCBT: 12 modules of sessions taken over 12 wk, with access to a therapist via a secure online contact system (time spent with a patient: 9 min/wk): cost of treatment £210
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Base-case analysis: ICER: £-6533 per QALY; cost saving Probability of iCBT being cost-effective compared with control at wtp of £5,000 per QALY: 77%
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| National Collaborating Centre for Mental Health and NICE, 2013,64 United Kingdom |
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Adults with social anxiety disorder (1.5% of all anxiety disorders) Mean age: NR Females: NR Hybrid decision tree: Markov model compared 28 interventions including drugs and iCBT; utilities: 0.866 associated with recovery and 0.659 with non-recovery, relapse
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Interventions: guided and unguided iCBT Comparators: waitlist control, drug (sertraline), placebo
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Total QALYs (mean per 1000 persons), iCBT vs. control: 1) guided: 3,540; 2) unguided iCBT: 3,848; 3) drug: 3,490; 4) waiting list: 3,366; 5) placebo: 3,401 Mean difference: NR
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Currency: £ Year: 2012 Total costs (mean), iCBT vs. control: 1) guided: 4.87 million; 2) unguided iCBT: 4.74 million; 3) drug: 4.27 million; 4) waiting list: 4.29 million; 5) placebo: 4.396 million Mean difference: NR Total costs of iCBT/drug include costs of visits to GP: 1 for iCBT and 7 for drugs: 1) guided: 877; 2) unguided iCBT: 649; 3) drug: 324; waiting list: 0
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| Joesch et al, 2012,55 United States |
Individual-level cost-effectiveness and cost–utility analysis Parallel-group RCT, 17 clinics in 4 US cities (Arkansas, California, and Washington) Health care payer perspective Time horizon: 18 mo Discount rate: 0%
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Adults aged 18–75 yr, English- or Spanish-speaking, with an anxiety disorder (moderate anxiety) by DSM-IV (N = 690) Mean age, iCBT vs. TAU: 44.7 (SD:12.8) vs. 45.6 (SD: 13.6) yr Females, iCBT vs. control: 72% vs. 71% 75%–78% had GAD, 62% with comorbid major depression at baseline; 57%–58% had more than 2 comorbid conditions 6 mo before baseline: 4 primary care visits and 1 ER visit, > 1 specialist visit
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Intervention: guided iCBT modules (CALM) provided within a collaborative-care case-management model offered a choice of CBT, anti-anxiety medication, or both (n = 349) Comparator: TAU (n = 341) iCBT within collaborative care model: online CALM modules, 10–12 wk, supported by nonexpert care manager; care managers involved in care: assisted with treatment adherence, medication optimization, and consults with psychiatrists as needed; duration of treatment 3–12 mo, first course of 3 mo; if patient wanted, could repeat course up to 3 times at 3-mo intervals; after finishing treatment, 1-mo calls from managers reinforced CBT skills, drug adherence, or both TAU: Usual care by GP, medication, counselling, or referral to a mental health specialist
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Total QALYs (mean), iCBT vs. TAU, baseline to 18 mo: EQ-5D, 1.17 (95% CI 1.14–1.19) vs. 1.11 (1.09–1.14); SF-6D, 1.05 (95% CI 1.04–1.07) vs. 1.00 (0.98–1.02) Mean difference, iCBT vs. TAU: EQ-5D, 0.05 (95% CI 0.01–0.09), SF-6D, 0.05 (95% CI 0.03–0.08)
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Currency: USD Year: 2009 Total costs (mean), iCBT vs. TAU, baseline to 18 mo: 7,310.5 (95% CI 6,669–7,951) vs. 7,065.7 (95% CI 6,325–7,806) Mean difference: 244.8 (95% CI −733 to 1,223)
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Base-case analysis (complete case analysis, non-parametric, for EQ-5D), iCBT vs. TAU, INB > 0 at wtp of 5,000, 95% CI around INB > 0 at 60,000 Scenario analysis (missing data imputation analysis, non-parametric, for EQ-5D), iCBT vs. TAU, INB > 0 at wtp of 10,000, 95% CI around INB > 0 at 80,000
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| Hedman et al, 2011,58 Sweden |
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Adults with SAD (N = 126) Mean age, iCBT vs. group CBT: 35.2 (SD: 11.2) vs. 35.5 (SD: 11.6) yr Females, iCBT vs. control: 37.5% vs. 33.9% Anxiety present for around 20 yr, 16% with comorbid major depression; 34% of patients in iCBT and 38% of patients in group CBT received additional treatment (CBT, psychological treatment, or drugs) after finalizing the intervention in year 1
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Intervention: guided iCBT modules including homework exercises (n = 64) Comparator: face-to-face group CBT (n = 62) iCBT: online modules, 15 wk, with access to a therapist (psychologist) and supportive email feedback via internet-based messaging system with no phone/face-to-face contact (10 min/wk); on average 9 of 15 modules completed, cost per treated patient was $464, and 5.5 min/wk of therapist's time Group iCBT: 15 sessions, 1 individual and 14 weekly group CBT sessions including homework between sessions, 2.5 hr long, groups of 6–7 patients, led by CBT-trained experienced psychotherapists; on average 9 of 15 sessions completed, cost per treated patient was $2,687 and 50 min/wk of therapist's time
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Total QALYs (mean), iCBT vs. group CBT, iCBT vs. group CBT, pre/post-treatment and 6 mo: before treatment, 0.77 (SD 0.18) vs. 0.74 (SD 0.19); 4 mo after treatment, 0.82 (SD: 0.14) vs. 0.80 (SD: 0.17); at 6 mo after treatment, 0.85 (SD: 0.14) vs. 0.81 (SD: 0.17) Mean difference, iCBT vs. group CBT: 0.075
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Currency: USD Year: 2009 Total costs (mean), iCBT, iCBT plus TAU, TAU (societal perspective): 9,457 (7,547–11,506) vs. 10,793 (8,412–13,328) vs. 11,244 (9,206–13,419) Total costs (mean), iCBT vs. group CBT, pre/post-treatment and 6 mo: before treatment, 7,048 (SD: 7,476) vs. 7,773 (SD: 7,926); 4 mo after treatment, $6,598 (SD: 7,337) vs. $8,648 (SD: 7,539); at 6 mo, $5,616 (SD: 7,456) vs. $7,650 (SD: 6,591) Mean difference: –$1,335
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Base-case analysis, iCBT vs. group CBT, ICER: −17,823 per QALY; cost saving and more effective Probability of iCBT being cost-effective compared with group CBT at wtp of 0 per QALY is 81% and at wtp of >40,000 per QALY is 79% Scenario analysis: costs of treatment only, iCBT vs. group CBT, ICER: −29,693 per QALY; cost saving and more effective
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| National Collaborating Centre for Mental Health and NICE, 2011,9 United Kingdom |
Cost–utility analysis Model-based analysis NHS and PSS perspective Time horizon: 12 mo Discount rate: 0%
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Adults with panic disorder (N = 21,000, 5% using iCBT of 425,000 patients in the UK) Mean age: NR Females: NR 4 decision tree models: active panic-free status or not after treatment, remain panic-free or return to panic state at follow-up (52 wk); No utility data for specific health states panic disorder; utilities extrapolated from an ESEMeD study that measured utilities using EQ-5D in people with panic disorder for more than 12 mo and those without panic disorder: 0.76 (95% CI 0.70–0.82) and 0.91 (95% CI 0.90–0.91), respectively
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Interventions: 1) Therapist-guided iCBT program “Panic Online”; 2) Guided iCBT “Internet Psykiatri” Comparators: 1) TAU or 2) clinician-led CBT iCBT: 12–14 wk, guided by a therapist (email messaging), follow-up at 52 weeks Model 1: Panic Online vs. TAU; Model 2: Panic Online vs. clinician-led CBT; Model 3: Internet Psychiatri vs. waiting list; Model 4: Internet Psychiatri vs. clinician-led CBT
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Total QALYs (mean per person), iCBT vs. control: 1) model 1: 85.46 vs. 80.79; 2) model 2: 83.059 vs. 83.29;3) model 3: 85.46 vs. 80.79; 4) model 4: 85.46 vs. 80.79 Mean difference: 1) model 1: 4.67; 2) model 2: −0.239; 3) model 3: 5.217;4) model 4: 1.25
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Currency: £ Year: 2009 Total costs (mean), iCBT vs. control: 1) model 1: 59,429 vs. 23,933; 2) model 2: 91,756 vs. 61,456;3) model 3: 32,702 vs. 21,140;4) model 4: 26,217 vs. 69,567 Mean difference: 1) model 1: 35,496; 2) model 2: 30,300; 3) model 3: 11,562;4) model 4: 43,350 Intervention costs included therapist's costs, hardware (4 per person per computer), capital overheads (27 per person), license fee (none), server/website hosting costs (negligible) Therapist's costs per patient based on time spent: 188–443, depending on model assumptions
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Base-case analysis: ICER: 1) model 1: 7,599/QALY; 2) model 2: 126,849 (saving ∼130,000 for one QALY lost);3) model 3: 2,216/QALY;4) model 4: dominant Probability of iCBT being cost-effective compared with control at wtp of 20,000 per QALY: 1) model 1: 92%; 2) model 2: 71%; 3) model 3: 85%; 4) model 4: 95%
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| Bergstrom et al, 2010,54 Sweden |
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Intervention: guided iCBT modules including homework exercises (n = 53) Comparator: face-to-face group CBT (n = 60) iCBT: 10 modules, 10 wk, with access to a therapist (psychologist) and supportive email feedback with no phone/face-to-face contact; on average 6.7 of 10 modules completed, and 35 min of therapist's time per patient (mean: 35.4 min, SD:19.6) Group iCBT: 10 sessions, group CBT including homework between sessions, 2 hr long, led by 2 trained psychotherapists; on average 8 of 10 sessions completed, on average 6 hr of therapist's time per patient
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Total response rate, iCBT vs. group CBT post-treatment: 60% vs. 63% Mean difference, iCBT vs. group CBT: NR
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Currency: € Year: NR Total costs (mean), iCBT vs. group CBT, post-treatment: 86 vs. 325 Mean difference: 239 Therapist costs per patient/group, iCBT vs. group CBT, post-treatment: 21 vs. 260
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Base-case analysis, iCBT vs. group CBT, ICER (calculated): 7,970 per responder; cost saving and less effective Probability of iCBT being cost-saving (south-west quadrant) compared with group CBT: 62%
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| Titov et al, 2009,53 Australia |
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Intervention: supported iCBT program “Shyness program” (n = 93) Comparator: TAU: waitlist control (n = 100) iCBT: 6 online sessions over 8–10 wk, supported by a clinical psychologist via email on regular basis, participation in online forum discussions and homework, completion rate: 79%
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Total YLDs averted (calculated using the disability weight transfer factor for social phobia of 0.1876), iCBT vs. control: effect size of 1.07 × 0.1876 = 0.2007 Mean difference: 0.2007 Acceptability of iCBT explored at 6 mo: 44% who previously used face-to-face CBT for social phobia preferred using iCBT (reasons: anonymity)
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Currency: AUD Year: 2008 Total costs (mean), iCBT vs. control: NR Mean difference: 300 Costs of treatment: 3 hr of clinician time per patient (3 × 100/hr)
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Base-case analysis: ICER: 1,495 per YLD averted Sensitivity analysis, estimating costs of group CBT (800 per participant) vs. waiting list, ICER: 5,686 per YLD averted
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| McCrone et al, 2009,52 United Kingdom |
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Intervention: iCBT modules “FearFighter” including homework (n = NR) Comparator: 1) face-to-face CBT (n = NR), and 2) computer-aided relaxation (n = NR) iCBT: 6 computer modules, self-guided, including homework; brief clinician in-person support at start and end of sessions (76 min over 10 wk) Face-to-face CBT: 6 sessions, individual inperson, 1 hr, including homework; relaxation: 6 computer-guided sessions; brief clinician in-person support at start and end of sessions (76 min over 10 wk)
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Total effects, iCBT vs. face-to-face CBT vs. relaxation, the mean improvement on the main problem ratings/global phobia rating: 3.95 vs. 3.93 vs. 0.71, P > .05/2.95 vs. 3.59 vs. 1.07, P > .05 Mean difference: NR
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Currency: £ Year: NR Total costs (mean), iCBT vs. face-to-face CBT vs. relaxation, assuming 196/patient: 281 (SD: 88) vs. 363 (SD: 158) vs. 110 (SD: 33) Mean difference, iCBT vs. relaxation/iCBT vs. face-to-face: 90% CI, 143–£198/90% CI, −129 to −31 Costs not collected, but estimated on basis of UK guidelines: cost of FearFighter, 196/patient in one GP practice, 111/patient in primary care trust; CBT therapist costs: 69/hr; relaxation treatment cost, 0/patient
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Base-case analysis: ICER, iCBT vs. relaxation/face-to-face vs. relaxation: 64–112 per point improvement/100–175 per point improvement Probability of iCBT/face-to-face CBT being cost-effective compared with relaxation was 50% at a wtp of 100 per point improvement; for all values of wtp, iCBT had less chance to be cost-effective than face-to-face CBT Cost-effectiveness of iCBT would be better if the salary of people supporting therapy was smaller (less well-trained clinicians)
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| Mihalopoulos et al, 2005,51 Australia |
Cost-effectiveness analysis Model-based analysis (using pilot RCT data) Health sector perspective Time horizon: 6 mo Discount rate: 0%
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Adults with panic disorder (NR, based on 2004 prevalence of panic disorder in Australia) Mean age, iCBT vs. control: NR Females, iCBT vs. control: NR
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Interventions: 1) therapist-guided iCBT program “Panic Online”; 2) GP-assisted iCBT “Panic Online” Comparator: face-to-face CBT by a GP or usual care (a mixture of no care/evidence-based principles and no-evidence-based medicine principles) iCBT: 1) 12-wk intervention comprising iCBT plus 12 weekly 45-min sessions with a publicly funded psychologist, and one consultation with GP; 2) 12-wk iCBT plus 6 consultations with a GP
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Total DALYs (mean), iCBT vs. usual care: NR Mean difference: 870 DALYs (90% CI 540–1,200) Assumed that effectiveness of iCBT is equal to effectiveness of face-to-face CBT
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Currency: AUD Year: NR Total costs (mean), iCBT by psychologist/iCBT by GP vs. usual care: NR Mean difference, iCBT by psychologist/iCBT by GP vs. usual care: $3.8 million (90% CI, 2.3–5.3 million)/2.8 million (90% CI, $1.7–3.9 million)
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Base-case analysis: ICER of iCBT by psychologist/by GP vs. usual care: 4,300/DALY averted/3,200/DALY averted Probability of iCBT (by a psychologist or a GP) being cost-effective was 100% at wtp of 10,000
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| Kaltenthaler, 2006,50 United Kingdom |
Cost–utility analysis Model-based analysis NHS perspective Time horizon: 12 mo Discount rate: 0%
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Adult patients with panic disorder Mean age, iCBT vs. control: NR Females, iCBT vs. control: NR Two-state Markov model with 3-mo cycle length (panic phobia or well); relapse rate (annual rate of 17%, 3-monthly rate of 0.045) assumed to be same for iCBT and face-to-face CBT; utilities assumed from ESEMeD study in patients with prior phobia: social phobia (0.79, 95% CI 0.75–0.84), agoraphobia (0.79, 95% CI 0.73–0.84) and specific phobia (0.82, 95%CI 0.80–0.85); well, no disorder (0.91, 95% CI 0.90–0.98)
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Interventions, commercial pay-to-use programs (ST Solutions): FearFighter Comparator: 1) iCBT for relaxation with brief coaching sessions of 5 min; 2) face-to-face CBT (6 hr of individual therapy) iCBT: FearFighter (6-session module) with telephone support line
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Total QALYs (mean), FearFighter vs. relaxation vs. face-to-face CBT: 0.794 vs. 0.736 vs. 0.805 Mean difference, FearFighter vs. relaxation/face-to-face CBT vs. FearFighter: 0.058/0.011
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Currency: £ Year: NR Total costs (mean), FearFighter vs. relaxation vs. face-to-face CBT: 217 vs. 78 vs. 410 Mean difference, FearFighter vs. relaxation/face-to-face CBT vs. FearFighter: 138/194
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Base-case anaysis: FearFighter vs. relaxation/face-to-face CBT vs. FearFighter, ICER: 2,380 per QALY/17,608 per QALY Probability of FearFighter vs. relaxation/face-to-face CBT vs. FearFighter at wtp 30,000 per QALY: 39%/61% Reduction of the cost of FearFighter would lead to increase in the ICER (face-to-face CBT vs. FearFighter) and better acceptability of iCBT program as compared with face-to-face CBT
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