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Optimal treatment for obsessive compulsive disorder: A randomized controlled feasibility study of the clinical-effectiveness and cost-effectiveness of cognitive-behavioural therapy, selective serotonin reuptake inhibitors and their combination in the management of obsessive compulsive disorder

Optimal treatment for obsessive compulsive disorder: A randomized controlled feasibility study of the clinical-effectiveness and cost-effectiveness of cognitive-behavioural therapy, selective serotonin reuptake inhibitors and their combination in the management of obsessive compulsive disorder
Optimal treatment for obsessive compulsive disorder: A randomized controlled feasibility study of the clinical-effectiveness and cost-effectiveness of cognitive-behavioural therapy, selective serotonin reuptake inhibitors and their combination in the management of obsessive compulsive disorder

Established treatments for obsessive compulsive disorder (OCD) include cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication. Combined treatment may outperform monotherapy, but few studies have investigated this. A total of 49 community-based adults with OCD were randomly assigned to CBT, SSRI, or SSRI+CBT. Sertraline (50-200 mg/day) was given as the SSRI for 52 weeks. A 16-h-manualized individual CBT was delivered over 8 weeks with four follow-up sessions. Assessors were 'blinded' to treatment allocation. A preliminary health economic evaluation was conducted. At week 16, combined treatment (n=13) was associated with the largest improvement, sertraline (n=7) the next largest and CBT (n=9) the smallest on the observed case analysis. The effect size (Cohen's d) comparing the improvement in Yale Brown Obsessive Compulsive Scale on CBT versus combined treatment was -0.39 and versus sertraline was -0.27. Between 16 and 52 weeks, the greatest clinical improvement was seen with sertraline, but participant discontinuation prevented reliable analysis. Compared with sertraline, the mean costs were higher for CBT and for combined treatment. The mean Quality Adjusted Life Year scores for sertraline were 0.1823 (95% confidence interval: 0.0447-0.3199) greater than for CBT and 0.1135 (95% confidence interval: 0.0290-0.2560), greater than for combined treatment. Combined treatment appeared the most clinically effective option, especially over CBT, but the advantages over SSRI monotherapy were not sustained beyond 16 weeks. SSRI monotherapy was the most cost-effective. A definitive study can and should be conducted.

cognitive behaviour therapy, feasibility, health economic, obsessive-compulsive disorder, randomized, sertraline
0268-1315
334-348
Fineberg, Naomi A.
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Baldwin, David S.
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Drummond, Lynne M.
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Wyatt, Solange
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Hanson, Jasmine
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Gopi, Srinivas
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Kaur, Sukhwinder
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Reid, Jemma
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Marwah, Virender
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Sachdev, Ricky A.
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Pampaloni, Ilenia
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Shahper, Sonia
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Varlakova, Yana
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Mpavaenda, Davis
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Manson, Christopher
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O'Leary, Cliodhna
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Irvine, Karen
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Monji-Patel, Deela
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Shodunke, Ayotunde
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Dyer, Tony
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Dymond, Amy
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Barton, Garry
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Wellsted, David
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Fineberg, Naomi A.
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Baldwin, David S.
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Drummond, Lynne M.
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Wyatt, Solange
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Hanson, Jasmine
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Gopi, Srinivas
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Kaur, Sukhwinder
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Reid, Jemma
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Marwah, Virender
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Sachdev, Ricky A.
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Pampaloni, Ilenia
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Shahper, Sonia
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Varlakova, Yana
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Mpavaenda, Davis
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Manson, Christopher
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O'Leary, Cliodhna
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Irvine, Karen
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Monji-Patel, Deela
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Shodunke, Ayotunde
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Dyer, Tony
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Dymond, Amy
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Barton, Garry
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Wellsted, David
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Fineberg, Naomi A., Baldwin, David S., Drummond, Lynne M., Wyatt, Solange, Hanson, Jasmine, Gopi, Srinivas, Kaur, Sukhwinder, Reid, Jemma, Marwah, Virender, Sachdev, Ricky A., Pampaloni, Ilenia, Shahper, Sonia, Varlakova, Yana, Mpavaenda, Davis, Manson, Christopher, O'Leary, Cliodhna, Irvine, Karen, Monji-Patel, Deela, Shodunke, Ayotunde, Dyer, Tony, Dymond, Amy, Barton, Garry and Wellsted, David (2018) Optimal treatment for obsessive compulsive disorder: A randomized controlled feasibility study of the clinical-effectiveness and cost-effectiveness of cognitive-behavioural therapy, selective serotonin reuptake inhibitors and their combination in the management of obsessive compulsive disorder. International Clinical Psychopharmacology, 33 (6), 334-348. (doi:10.1097/YIC.0000000000000237).

Record type: Article

Abstract

Established treatments for obsessive compulsive disorder (OCD) include cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication. Combined treatment may outperform monotherapy, but few studies have investigated this. A total of 49 community-based adults with OCD were randomly assigned to CBT, SSRI, or SSRI+CBT. Sertraline (50-200 mg/day) was given as the SSRI for 52 weeks. A 16-h-manualized individual CBT was delivered over 8 weeks with four follow-up sessions. Assessors were 'blinded' to treatment allocation. A preliminary health economic evaluation was conducted. At week 16, combined treatment (n=13) was associated with the largest improvement, sertraline (n=7) the next largest and CBT (n=9) the smallest on the observed case analysis. The effect size (Cohen's d) comparing the improvement in Yale Brown Obsessive Compulsive Scale on CBT versus combined treatment was -0.39 and versus sertraline was -0.27. Between 16 and 52 weeks, the greatest clinical improvement was seen with sertraline, but participant discontinuation prevented reliable analysis. Compared with sertraline, the mean costs were higher for CBT and for combined treatment. The mean Quality Adjusted Life Year scores for sertraline were 0.1823 (95% confidence interval: 0.0447-0.3199) greater than for CBT and 0.1135 (95% confidence interval: 0.0290-0.2560), greater than for combined treatment. Combined treatment appeared the most clinically effective option, especially over CBT, but the advantages over SSRI monotherapy were not sustained beyond 16 weeks. SSRI monotherapy was the most cost-effective. A definitive study can and should be conducted.

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Accepted/In Press date: 14 June 2018
e-pub ahead of print date: 12 July 2018
Published date: 1 November 2018
Keywords: cognitive behaviour therapy, feasibility, health economic, obsessive-compulsive disorder, randomized, sertraline

Identifiers

Local EPrints ID: 425646
URI: http://eprints.soton.ac.uk/id/eprint/425646
ISSN: 0268-1315
PURE UUID: 2c0ce527-ac9c-42ed-ac3c-3e18f410ba4f

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Date deposited: 30 Oct 2018 17:30
Last modified: 16 Dec 2019 17:55

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Contributors

Author: Naomi A. Fineberg
Author: Lynne M. Drummond
Author: Solange Wyatt
Author: Jasmine Hanson
Author: Srinivas Gopi
Author: Sukhwinder Kaur
Author: Jemma Reid
Author: Virender Marwah
Author: Ricky A. Sachdev
Author: Ilenia Pampaloni
Author: Sonia Shahper
Author: Yana Varlakova
Author: Davis Mpavaenda
Author: Christopher Manson
Author: Cliodhna O'Leary
Author: Karen Irvine
Author: Deela Monji-Patel
Author: Ayotunde Shodunke
Author: Tony Dyer
Author: Amy Dymond
Author: Garry Barton
Author: David Wellsted

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