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

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.

[1]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[2]  G. Andersson,et al.  Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial , 2011, PloS one.

[3]  G. Andersson,et al.  Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial. , 2011, The British journal of psychiatry : the journal of mental science.

[4]  R. Gallop,et al.  Time to relapse after 6 and 12 months' treatment of generalized anxiety disorder with venlafaxine extended release. , 2010, Archives of general psychiatry.

[5]  P. Fink,et al.  The Outcome of Health Anxiety in Primary Care. A Two-Year Follow-up Study on Health Care Costs and Self-Rated Health , 2010, PloS one.

[6]  D. Ahern,et al.  A Roadmap to Computer‐Based Psychotherapy in the United States , 2010, Harvard review of psychiatry.

[7]  G. Andersson,et al.  Guided and unguided self-help for social anxiety disorder: randomised controlled trial. , 2009, The British journal of psychiatry : the journal of mental science.

[8]  G. Andersson.  Using the Internet to provide cognitive behaviour therapy. , 2009, Behaviour research and therapy.

[9]  P. Salkovskis,et al.  Cognitive–behavioural therapy for health anxiety in a genitourinary medicine clinic: randomised controlled trial , 2008, British Journal of Psychiatry.

[10]  E. Ferguson.  A taxometric analysis of health anxiety , 2008, Psychological Medicine.

[11]  W. W. Stone,et al.  Treating Health Anxiety and Fear of Death: A Practitioner's Guide , 2007 .

[12]  J. Ballenger.  Cost-effectiveness of preventing depression in primary care patients: Randomised trialSmit F, Willemse G, Koopmanschap M, et al (Free Univ, Amsterdam; Trimbos Inst, Utrecht, The Netherlands; Erasmus Med Centre, Rotterdam, The Netherlands; et al) Br J Psychiatry 188:330–336, 2006§ , 2007 .

[13]  M. Kenward,et al.  An Introduction to the Bootstrap , 2007 .

[14]  C. Sherbourne,et al.  Incremental cost-effectiveness of a collaborative care intervention for panic disorder , 2006, Psychological Medicine.

[15]  J. Lave,et al.  Willingness to Pay for a Quality-Adjusted Life Year: Implications for Societal Health Care Resource Allocation , 2005, Medical decision making : an international journal of the Society for Medical Decision Making.

[16]  J. A. Boer,et al.  Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology , 2005, Journal of psychopharmacology.

[17]  Shahm Martini,et al.  Treating Health Anxiety: A Cognitive-Behavioral Approach , 2005 .

[18]  Martin Knapp,et al.  A comparison of two methods of collecting economic data in primary care. , 2005, Family practice.

[19]  P. Salkovskis,et al.  Prevalence and service implications of health anxiety in genitourinary medicine clinics , 2004, International journal of STD & AIDS.

[20]  Gerard F Anderson,et al.  U.S. health care spending in an international context. , 2004, Health affairs.

[21]  David K Ahern,et al.  Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. , 2004, JAMA.

[22]  J. Krystal,et al.  Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. , 2004, Archives of general psychiatry.

[23]  G. Andrews,et al.  Modelling the population cost-effectiveness of current and evidence-based optimal treatment for anxiety disorders , 2004, Psychological Medicine.

[24]  C. Faravelli,et al.  Epidemiology of somatoform disorders: a community survey in Florence , 2004, Social Psychiatry and Psychiatric Epidemiology.

[25]  K. Cavanagh,et al.  Geographic inequity in the availability of cognitive behavioural therapy in England and Wales , 2003 .

[26]  B. Everitt,et al.  Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice , 2003, Psychological Medicine.

[27]  M. Keller,et al.  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 , 2003, Depression and anxiety.

[28]  P. Salkovskis,et al.  The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis , 2002, Psychological Medicine.

[29]  R. Mayou.  Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions , 2002, BMJ : British Medical Journal.

[30]  John E. Cooper,et al.  Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision) (DSM-IV-TR) , 2001, British Journal of Psychiatry.

[31]  S. Teutsch,et al.  The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services. , 2001, American journal of preventive medicine.

[32]  R. Rabin,et al.  EQ-SD: a measure of health status from the EuroQol Group , 2001, Annals of medicine.

[33]  P. Salkovskis,et al.  Two psychological treatments for hypochondriasis , 1998, British Journal of Psychiatry.

[34]  D. Ahern,et al.  A prospective 4- to 5-year study of DSM-III-R hypochondriasis. , 1998, Archives of general psychiatry.

[35]  P. Dolan,et al.  Modeling valuations for EuroQol health states. , 1997, Medical care.

[36]  P. Salkovskis,et al.  A Controlled Trial of Cognitive–Behavioural Treatment of Hypochondriasis , 1996, British Journal of Psychiatry.

[37]  A. V. van Hemert,et al.  A validation study of the Whitely Index, the Illness Attitude Scales, and the Somatosensory Amplification Scale in general medical and general practice patients. , 1996, Journal of psychosomatic research.

[38]  P. Svanborg,et al.  A new self‐rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale , 1994, Acta psychiatrica Scandinavica.

[39]  John E. Cornell,et al.  Clinical Validation of the Quality of Life Inventory: A Measure of Life Satisfaction for Use in Treatment Planning and Outcome Assessment , 1992 .

[40]  A. Williams.  EuroQol : a new facility for the measurement of health-related quality of life , 1990 .

[41]  A. Kasuya.  EuroQol--a new facility for the measurement of health-related quality of life. , 1990, Health policy.

[42]  A. Beck,et al.  An inventory for measuring clinical anxiety: psychometric properties. , 1988, Journal of consulting and clinical psychology.

[43]  S. Reiss,et al.  Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. , 1986, Behaviour research and therapy.

[44]  I. Pilowsky,et al.  Dimensions of Hypochondriasis , 1967, British Journal of Psychiatry.

[45]  J. Little.  A Proof for the Queuing Formula: L = λW , 1961 .