Sampaio F¹, Bonnert M^2,3, Olén O^4,5, Hedman E^2,6, Lalouni M^3,4, Lenhard F^3,7, Ljótsson B^2,7, Ssegonja R¹, Serlachius E^3,7, Feldman I¹. BMJ Open. 2019 Jan 24;9(1):e023881. doi: 10.1136/bmjopen-2018-023881.

Author information

1 Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden.

2 Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

3 Stockholm Health Care Services, Stockholms Lans Landsting, Stockholm, Sweden.

4 Department of Medicine, Karolinska Institutet, Stockholm, Sweden.

5 Department of Pediatric Gastroenterology and Nutrition, Sachs' Children's Hospital, Stockholm, Sweden.

6 Department of Clinical Neuroscience, Osher Centre for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden.

7 Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.

Abstract

OBJECTIVE: To assess whether exposure-based internet-delivered cognitive-behavioural therapy (internet-CBT) is a cost-effective treatment for adolescents with irritable bowel syndrome (IBS) compared with a waitlist control, from a societal perspective, based on data from a randomised trial.

DESIGN: Within-trial cost-effectiveness analysis.

SETTING: Participants were recruited from the whole of Sweden via primary, secondary and tertiary care clinics reached through news media and advertising.

PARTICIPANTS: Adolescents (aged 13-17) with a diagnosis of IBS.

INTERVENTIONS: Participants were randomised to either an exposure-based internet-CBT, including 10 weekly modules for adolescents and five modules for parents, or a waitlist.

OUTCOME MEASURES: The main health outcome was the quality-adjusted life-year (QALY) estimated by mapping Pediatric Quality-of-Life Inventory (PedsQL) scores onto EQ-5D-3L utilities. The secondary outcome was the point improvement on the PedsQL scale. Data on health outcomes and resource use were collected at baseline and 10 weeks post-treatment. Resource use was measured using the Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry (TIC-P) . Incremental cost-effectiveness ratios (ICER) were calculated as the difference in average costs by the difference in average outcomes between groups.

RESULTS: The base-case results showed that internet-CBT costs were on average US$170.24 (95% CI 63.14 to 315.04) more per participant than the waitlist. Adolescents in the internet-CBT group showed small QALY gains (0.0031; 95% CI 0.0003 to 0.0061), and an average improvement of 5.647 points (95% CI 1.82 to 9.46) on the PedsQL compared with the waitlist. Internet-CBT yielded an ICER of $54 916/QALY gained and a probability of cost-effectiveness of 74% given the Swedish willingness-to-pay threshold. The ICER for the outcome PedsQL was US$85.29/point improvement.

CONCLUSIONS: Offering internet-CBT to adolescents with IBS improves health-related quality of life and generates small QALY gains at a higher cost than a waitlist control. Internet-CBT is thus likely to be cost-effective given the strong efficacy evidence, small QALY gains and low cost.

TRIAL REGISTRATION NUMBER: NCT02306369; Results.