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Cost effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome: the ACTIB randomised trial

Cost effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome: the ACTIB randomised trial
Cost effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome: the ACTIB randomised trial

Background: Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiveness of the interventions. Methods: Participants were recruited from 74 general practices and three gastroenterology centres in England. Interventions costs were calculated, and other service use and lost employment measured and costed for one-year post randomisation. Quality-adjusted life years (QALYs) were combined with costs to determine cost-effectiveness of TCBT and WCBT compared to TAU. Results: TCBT cost £956 more than TAU (95% CI, £601–£1435) and generated 0.0429 more QALYs. WCBT cost £224 more than TAU (95% CI, − £11 to £448) and produced 0.029 more QALYs. Compared to TAU, TCBT had an incremental cost per QALY of £22,284 while the figure for WCBT was £7724. After multiple imputation these ratios increased to £27,436 and £17,388 respectively. Including lost employment and informal care, TCBT had costs that were on average £866 lower than TAU (95% CI, − £1133 to £2957), and WCBT had costs that were £1028 lower than TAU (95% CI, − £448 to £2580). Conclusions: TCBT and WCBT resulted in more QALYs and higher costs than TAU. Complete case analysis suggests both therapies are cost-effective from a healthcare perspective. Imputation for missing data reduces cost-effectiveness but WCTB remained cost-effective. If the reduced societal costs are included both interventions are likely to be more cost-effective. Trial registration ISRCTN44427879 (registered 18.11.13).

Cognitive behavioural therapy, Cost-effectiveness, Economic evaluation, Irritable bowel syndrome
1471-230X
McCrone, Paul
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Everitt, Hazel
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Landau, Sabine
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Bishop, Felicity L.
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O'Reilly, Gillian
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Sibelli, Alice
1e08ac66-7ac6-4d76-a2ce-fa99d7115955
Holland, Rachel
ac9b0081-e038-4a25-9d63-bb8b1a4830fb
Hughes, Stephanie
a6d39500-67ff-4d7a-a1dc-8e42f80945ff
Windgassen, Sula
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Goldsmith, Kim
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Coleman, Nicholas
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Logan, Robert
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Chalder, Trudie
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Moss-Morris, Rona
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McCrone, Paul
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Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef
Landau, Sabine
9a3191cc-3fd7-4d83-beac-51df5a7db279
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Bishop, Felicity L.
1f5429c5-325f-4ac4-aae3-6ba85d079928
O'Reilly, Gillian
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Sibelli, Alice
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Holland, Rachel
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Hughes, Stephanie
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Windgassen, Sula
d9e22cbc-658f-4ba6-89b2-83f51eb4d15d
Goldsmith, Kim
cfac3044-4f30-44e8-9950-18fee2c55d60
Coleman, Nicholas
4768549b-3384-4d1e-b2e8-d515e5c9d550
Logan, Robert
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Chalder, Trudie
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Moss-Morris, Rona
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McCrone, Paul, Everitt, Hazel, Landau, Sabine, Little, Paul, Bishop, Felicity L., O'Reilly, Gillian, Sibelli, Alice, Holland, Rachel, Hughes, Stephanie, Windgassen, Sula, Goldsmith, Kim, Coleman, Nicholas, Logan, Robert, Chalder, Trudie and Moss-Morris, Rona (2021) Cost effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome: the ACTIB randomised trial. BMC Gastroenterology, 21 (1), [276]. (doi:10.1186/s12876-021-01848-9).

Record type: Article

Abstract

Background: Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiveness of the interventions. Methods: Participants were recruited from 74 general practices and three gastroenterology centres in England. Interventions costs were calculated, and other service use and lost employment measured and costed for one-year post randomisation. Quality-adjusted life years (QALYs) were combined with costs to determine cost-effectiveness of TCBT and WCBT compared to TAU. Results: TCBT cost £956 more than TAU (95% CI, £601–£1435) and generated 0.0429 more QALYs. WCBT cost £224 more than TAU (95% CI, − £11 to £448) and produced 0.029 more QALYs. Compared to TAU, TCBT had an incremental cost per QALY of £22,284 while the figure for WCBT was £7724. After multiple imputation these ratios increased to £27,436 and £17,388 respectively. Including lost employment and informal care, TCBT had costs that were on average £866 lower than TAU (95% CI, − £1133 to £2957), and WCBT had costs that were £1028 lower than TAU (95% CI, − £448 to £2580). Conclusions: TCBT and WCBT resulted in more QALYs and higher costs than TAU. Complete case analysis suggests both therapies are cost-effective from a healthcare perspective. Imputation for missing data reduces cost-effectiveness but WCTB remained cost-effective. If the reduced societal costs are included both interventions are likely to be more cost-effective. Trial registration ISRCTN44427879 (registered 18.11.13).

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ACTIB paper (McCrone et al 11.5.2021) final accepted manuscript
Available under License Creative Commons Attribution.
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Published date: 6 July 2021
Additional Information: Funding Information: The project ACTIB (Assessing Cognitive–behavioural Therapy in Irritable Bowel syndrome)—a randomised controlled trial of clinical and cost-effectiveness of therapist-delivered cognitive–behavioural therapy and web-based self-management in irritable bowel syndrome—was funded by the National Institute for Health Research (NIHR) HTA Project: 11/69/02, with additional support from the NIHR Clinical Research Network. This paper represents independent research with some staff part funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. Details of this study have previously been reported in https://eprints.soton.ac.uk/431211/1/Published_ACTIB_HTA_report_May_2019.pdf . PL was director of the National Institute for Health Research (NIHR) Programme Grants for Applied Research (PGfAR) and a member of the Journals Library Board. TC reports grants from Guy’s and St Thomas’ Charity. She was a Faculty member, 3rd International Conference on Functional (Psychogenic) Neurological Disorders, Sept 2017, Edinburgh, Member of the IAPT Education and Training ERG (2016-), Member of the IAPT Outcomes and Informatics Meeting (2016), President of the British Association of Behavioural and Cognitive Psychotherapies (2012–2015) for which she did not receive payment. Workshops were delivered on medically unexplained symptoms, during the conduct of the study (money paid into KCL for future research). TC has a patent Background IP—manuals were developed prior to trial starting. SL and KG report grants from NIHR. The TSC Chair, PW, was a colleague of TC in the past but he has recently retired. RMM reports personal fees from training in IBS intervention for Central and North west London NHS Foundation Trust and University of East Anglia outside of the submitted work. Since this study was completed, she has received payment for consultancy to Mahana Therapeutics. Since this study was completed, a private company has signed a licence agreement with King’s College London with the view to bringing the Regul8 website product to the NHS and other international markets. RMM, HE, TC, AS, GOR will be beneficiaries of this licence through contracts with their respective Universities. The patient manual is background IP developed by CI's RMM and TC in previous work. Funding Information: PL was director of the National Institute for Health Research (NIHR) Programme Grants for Applied Research (PGfAR) and a member of the Journals Library Board. TC reports grants from Guy’s and St Thomas’ Charity. She was a Faculty member, 3rd International Conference on Functional (Psychogenic) Neurological Disorders, Sept 2017, Edinburgh , Member of the IAPT Education and Training ERG (2016-), Member of the IAPT Outcomes and Informatics Meeting (2016), President of the British Association of Behavioural and Cognitive Psychotherapies (2012-2015) for which she did not receive payment. Workshops were delivered on medically unexplained symptoms, during the conduct of the study (money paid into KCL for future research). TC has a patent Background IP - manuals were developed prior to trial starting. SL and KG report grants from NIHR. The TSC Chair, PW, was a colleague of TC in the past but he has recently retired. RMM reports personal fees from training in IBS intervention for Central and North west London NHS Foundation Trust and University of East Anglia outside of the submitted work. Since this study was completed, she has received payment for consultancy to Mahana Therapeutics. Since this study was completed, a private company has signed a licence agreement with King’s College London with the view to bringing the Regul8 website product to the NHS and other international markets. RMM, HE, TC, AS, GOR will be beneficiaries of this licence through contracts with their respective Universities. The patient manual is background IP developed by CI's RMM and TC in previous work. No conflicts of interests for FB, RH, SL, SH, SW, PMc, NC, RL. Funding Information: The project ACTIB (Assessing Cognitive?behavioural Therapy in Irritable Bowel syndrome)?a randomised controlled trial of clinical and cost-effectiveness of therapist-delivered cognitive?behavioural therapy and web-based self-management in irritable bowel syndrome?was funded by the National Institute for Health Research (NIHR) HTA Project: 11/69/02, with additional support from the NIHR Clinical Research Network. This paper represents independent research with some staff part funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King?s College London. Details of this study have previously been reported in https://eprints.soton.ac.uk/431211/1/Published_ACTIB_HTA_report_May_2019.pdf. PL was director of the National Institute for Health Research (NIHR) Programme Grants for Applied Research (PGfAR) and a member of the Journals Library Board. TC reports grants from Guy?s and St Thomas? Charity. She was a Faculty member, 3rd International Conference on Functional (Psychogenic) Neurological Disorders, Sept 2017, Edinburgh, Member of the IAPT Education and Training ERG (2016-), Member of the IAPT Outcomes and Informatics Meeting (2016), President of the British Association of Behavioural and Cognitive Psychotherapies (2012?2015) for which she did not receive payment. Workshops were delivered on medically unexplained symptoms, during the conduct of the study (money paid into KCL for future research). TC has a patent Background IP?manuals were developed prior to trial starting. SL and KG report grants from NIHR. The TSC Chair, PW, was a colleague of TC in the past but he has recently retired. RMM reports personal fees from training in IBS intervention for Central and North west London NHS Foundation Trust and University of East Anglia outside of the submitted work. Since this study was completed, she has received payment for consultancy to Mahana Therapeutics. Since this study was completed, a private company has signed a licence agreement with King?s College London with the view to bringing the Regul8 website product to the NHS and other international markets. RMM, HE, TC, AS, GOR will be beneficiaries of this licence through contracts with their respective Universities. The patient manual is background IP developed by CI's RMM and TC in previous work. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: Cognitive behavioural therapy, Cost-effectiveness, Economic evaluation, Irritable bowel syndrome

Identifiers

Local EPrints ID: 449309
URI: http://eprints.soton.ac.uk/id/eprint/449309
ISSN: 1471-230X
PURE UUID: ed3085a7-da11-4fd8-8ede-671e13a75fa8
ORCID for Hazel Everitt: ORCID iD orcid.org/0000-0001-7362-8403
ORCID for Felicity L. Bishop: ORCID iD orcid.org/0000-0002-8737-6662
ORCID for Stephanie Hughes: ORCID iD orcid.org/0000-0003-4801-8245

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Date deposited: 24 May 2021 16:31
Last modified: 04 May 2022 01:43

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Contributors

Author: Paul McCrone
Author: Hazel Everitt ORCID iD
Author: Sabine Landau
Author: Paul Little
Author: Gillian O'Reilly
Author: Alice Sibelli
Author: Rachel Holland
Author: Sula Windgassen
Author: Kim Goldsmith
Author: Nicholas Coleman
Author: Robert Logan
Author: Trudie Chalder
Author: Rona Moss-Morris

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