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Cost-effectiveness and long-term effectiveness of Internet-based cognitive behaviour therapy for severe health anxiety

Published online by Cambridge University Press:  21 May 2012

E. Hedman ,
E. Andersson ,
N. Lindefors ,
G. Andersson ,
C. Rück  and
B. Ljótsson
E. Hedman*
Affiliation:
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Osher Centre for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
E. Andersson
Affiliation:
Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
N. Lindefors
Affiliation:
Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
G. Andersson
Affiliation:
Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
C. Rück
Affiliation:
Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
B. Ljótsson
Affiliation:
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
*
*Address for correspondence: E. Hedman, Ph.D., Karolinska Institutet, Department of Clinical Neuroscience, SE-171 77 Stockholm, Sweden. (Email: [email protected])
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Abstract

Background

Severe health anxiety is a common condition associated with functional disability, making it a costly disorder from a societal perspective. Internet-based cognitive behaviour therapy (ICBT) is a promising treatment but no previous study has assessed the cost-effectiveness or long-term outcome of ICBT for severe health anxiety. The aim of this study was to investigate the cost-effectiveness and 1-year treatment effects of ICBT for severe health anxiety.

Method

Cost-effectiveness and 1-year follow-up data were obtained from a randomized controlled trial (RCT) comparing ICBT (n = 40) to an attention control condition (CC, n = 41). The primary outcome measure was the Health Anxiety Inventory (HAI). A societal perspective was taken and incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling.

Results

The main ICER was −£1244, indicating the societal economic gain for each additional case of remission when administering ICBT. Baseline to 1-year follow-up effect sizes on the primary outcome measure were large (d = 1.71–1.95).

Conclusions

ICBT is a cost-effective treatment for severe health anxiety that can produce substantial and enduring effects.

Keywords

Cognitive behaviour therapycost-effectivenesshealth anxietyInternet
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 2 , February 2013 , pp. 363 - 374
Copyright
Copyright © Cambridge University Press 2012

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References

Andersson, G (2009). Using the Internet to provide cognitive behaviour therapy. Behaviour Research and Therapy 47, 175–180.CrossRefGoogle ScholarPubMed
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.Google Scholar
Asmundson, GJG, Taylor, S, Cox, BJ (2001). Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions. Wiley: Chichester.Google Scholar
Baldwin, DS, Anderson, IM, Nutt, DJ, Bandelow, B, Bond, A, Davidson, JR, den Boer, JA, Fineberg, NA, Knapp, M, Scott, J, Wittchen, HU (2005). Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 19, 567–596.CrossRefGoogle ScholarPubMed
Barsky, AJ, Ahern, DK (2004). Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. Journal of the American Medical Association 291, 1464–1470.CrossRefGoogle ScholarPubMed
Barsky, AJ, Fama, JM, Bailey, ED, Ahern, DK (1998). A prospective 4- to 5-year study of DSM-III-R hypochondriasis. Archives of General Psychiatry 55, 737–744.CrossRefGoogle ScholarPubMed
Beck, AT, Epstein, N, Brown, G, Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893–897.CrossRefGoogle ScholarPubMed
Cartreine, JA, Ahern, DK, Locke, SE (2010). A roadmap to computer-based psychotherapy in the United States. Harvard Review of Psychiatry 18, 80–95.CrossRefGoogle ScholarPubMed
Clark, DM, Salkovskis, PM, Hackmann, A, Wells, A, Fennell, M, Ludgate, J, Ahmad, S, Richards, HC, Gelder, M (1998). Two psychological treatments for hypochondriasis. A randomised controlled trial. British Journal of Psychiatry 173, 218–225.CrossRefGoogle ScholarPubMed
Dolan, P (1997). Modeling valuations for EuroQol health states. Medical Care 35, 1095–1108.CrossRefGoogle ScholarPubMed
Drummond, MF, Sculpher, MJ, Torrence, GW, O'Brien, BJ, Stoddart, GL (2005). Methods for the Evaluation of Health Care Programmes. Oxford University Press: Oxford.CrossRefGoogle Scholar
Efron, B, Tibshirani, RJ (1993). An Introduction to the Bootstrap. Chapman & Hall: New York.CrossRefGoogle Scholar
EuroQol Group (1990). EuroQol – a new facility for the measurement of health-related quality of life. Health Policy 16, 199–208.CrossRefGoogle Scholar
Faravelli, C, Salvatori, S, Galassi, F, Aiazzi, L, Drei, C, Cabras, P (1997). Epidemiology of somatoform disorders: a community survey in Florence. Social Psychiatry and Psychiatric Epidemiology 32, 24–29.CrossRefGoogle ScholarPubMed
Ferguson, E (2009). A taxometric analysis of health anxiety. Psychological Medicine 39, 277–285.CrossRefGoogle ScholarPubMed
Fink, P, Ornbol, E, Christensen, KS (2010). The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health. PLoS ONE 5, e9873.CrossRefGoogle ScholarPubMed
Frisch, MB, Cornell, J, Villanueva, M, Retzlaff, PJ (1992). Clinical validation of the Quality of Life Inventory. A measure of life satisfaction for use in treatment planning and outcome assessment. Psychological Assessment 4, 92–101.CrossRefGoogle Scholar
Furer, P, Walker, JR, Stein, MB (2007). Treating Health Anxiety and Fear of Death: A Practitioner's Guide. Springer: New York, NY.CrossRefGoogle Scholar
Furmark, T, Carlbring, P, Hedman, E, Sonnenstein, A, Clevberger, P, Bohman, B, Eriksson, A, Hallen, A, Frykman, M, Holmstrom, A, Sparthan, E, Tillfors, M, Ihrfelt, EN, Spak, M, Ekselius, L, Andersson, G (2009). Guided and unguided self-help for social anxiety disorder: randomised controlled trial. British Journal of Psychiatry 195, 440–447.CrossRefGoogle ScholarPubMed
Gueorguieva, R, Krystal, JH (2004). Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Archives of General Psychiatry 61, 310–317.CrossRefGoogle ScholarPubMed
Hakkaart-van Roijen, L, Donker, MCH (2002). Manual Trimbos/iMTA Questionnaire for Costs Associated with Psychiatric Illness (http://hdl.handle.net/1765/1337) [in Dutch]. Institute for Medical Technology Assessment: Rotterdam. Accessed April 2011.Google Scholar
Hedman, E, Andersson, G, Andersson, E, Ljotsson, B, Ruck, C, Asmundson, GJ, Lindefors, N (2011 a). Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial. British Journal of Psychiatry 198, 230–236.CrossRefGoogle ScholarPubMed
Hedman, E, Andersson, G, Ljótsson, B, Andersson, E, Rück, C, Mörtberg, E, Lindefors, N (2011 b). Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: a randomized controlled non-inferiority trial. PLoS ONE 6, e18001.CrossRefGoogle ScholarPubMed
Issakidis, C, Sanderson, K, Corry, J, Andrews, G, Lapsley, H (2004). Modelling the population cost-effectiveness of current and evidence-based optimal treatment for anxiety disorders. Psychological Medicine 34, 19–35.CrossRefGoogle ScholarPubMed
Katon, W, Russo, J, Sherbourne, C, Stein, MB, Craske, M, Fan, MY, Roy-Byrne, P (2006). Incremental cost-effectiveness of a collaborative care intervention for panic disorder. Psychological Medicine 36, 353–363.CrossRefGoogle ScholarPubMed
King, Jr. JT, Tsevat, J, Lave, JR, Roberts, MS (2005). Willingness to pay for a quality-adjusted life year: implications for societal health care resource allocation. Medical Decision Making 25, 667–677.CrossRefGoogle ScholarPubMed
Little, JDC (1961). A proof for the queuing formula: L = λW. Operations Research 9, 383–387.CrossRefGoogle Scholar
National Board of Health and Welfare (2011). National guidelines for depression and anxiety (http://www.socialstyrelsen.se/nationellariktlinjerfordepressionochangest). Accessed 15 February 2011.Google Scholar
OECD (2006). PPPs and Exchange Rates 2006. Organization for Economic Cooperation and Development (www.oecd.org). Accessed 8 September 2011.Google Scholar
Patel, A, Rendu, A, Moran, P, Leese, M, Mann, A, Knapp, M (2005). A comparison of two methods of collecting economic data in primary care. Family Practice 22, 323–327.CrossRefGoogle ScholarPubMed
Pilowsky, I (1967). Dimensions of hypochondriasis. British Journal of Psychiatry 113, 89–93.CrossRefGoogle ScholarPubMed
Proudfoot, J, Goldberg, D, Mann, A, Everitt, B, Marks, I, Gray, JA (2003). Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. Psychological Medicine 33, 217–227.CrossRefGoogle ScholarPubMed
Rabin, R, Charro, Fd (2001). EQ-SD: a measure of health status from the EuroQol Group. Annals of Medicine 33, 337–343.CrossRefGoogle Scholar
Reinhardt, UE, Hussey, PS, Anderson, GF (2004). U.S. health care spending in an international context. Health Affairs 23, 10–25.CrossRefGoogle Scholar
Reiss, S, Peterson, RA, Gursky, DM, McNally, RJ (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy 24, 1–8.CrossRefGoogle ScholarPubMed
Rickels, K, Etemad, B, Khalid-Khan, S, Lohoff, FW, Rynn, MA, Gallop, RJ (2010). Time to relapse after 6 and 12 months' treatment of generalized anxiety disorder with venlafaxine extended release. Archives of General Psychiatry 67, 1274–1281.CrossRefGoogle ScholarPubMed
Saha, S, Hoerger, TJ, Pignone, MP, Teutsch, SM, Helfand, M, Mandelblatt, JS (2001). The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services. American Journal of Preventive Medicine 20, 36–43.CrossRefGoogle ScholarPubMed
Salkovskis, PM, Rimes, KA, Warwick, HM, Clark, DM (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine 32, 843–853.CrossRefGoogle ScholarPubMed
Seivewright, H, Green, J, Salkovskis, P, Barrett, B, Nur, U, Tyrer, P (2008). Cognitive-behavioural therapy for health anxiety in a genitourinary medicine clinic: randomised controlled trial. British Journal of Psychiatry 193, 332–337.CrossRefGoogle Scholar
Seivewright, H, Salkovskis, P, Green, J, Mullan, N, Behr, G, Carlin, E, Young, S, Goldmeier, D, Tyrer, P (2004). Prevalence and service implications of health anxiety in genitourinary medicine clinics. International Journal of STD and AIDS 15, 519–522.CrossRefGoogle ScholarPubMed
Shapiro, DA, Cavanagh, K, Lomas, H (2003). Geographic inequity in the availability of cognitive behavioural therapy in England and Wales. Behavioural and Cognitive Psychotherapy 31, 185–192.CrossRefGoogle Scholar
Smit, F, Willemse, G, Koopmanschap, M, Onrust, S, Cuijpers, P, Beekman, A (2006). Cost-effectiveness of preventing depression in primary care patients: randomised trial. British Journal of Psychiatry 188, 330–336.CrossRefGoogle ScholarPubMed
Speckens, AE, Spinhoven, P, Sloekers, PP, Bolk, JH, van Hemert, AM (1996). A validation study of the Whitely Index, the Illness Attitude Scales, and the Somatosensory Amplification Scale in general medical and general practice patients. Journal of Psychosomatic Research 40, 95–104.CrossRefGoogle ScholarPubMed
Svanborg, P, Åsberg, M (1994). A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatrica Scandinavica 89, 21–28.CrossRefGoogle ScholarPubMed
Taylor, S, Asmundson, GJG (2004). Treating Health Anxiety: A Cognitive-Behavioral Approach. Guilford Press: New York.Google Scholar
Warwick, H, Clark, D, Cobb, A, Salkovskis, P (1996). A controlled trial of cognitive-behavioural treatment of hypochondriasis. British Journal of Psychiatry 169, 189–195.CrossRefGoogle ScholarPubMed
Yonkers, KA, Bruce, SE, Dyck, IR, Keller, MB (2003). Chronicity, relapse, and illness – course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up. Depression and Anxiety 17, 173–179.CrossRefGoogle ScholarPubMed