TY - JOUR
T1 - Cost effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome: the ACTIB randomised trial
AU - McCrone, Paul
AU - Everitt, Hazel
AU - Landau, Sabine
AU - Little, Paul
AU - Bishop, Felicity L.
AU - O'Reilly, Gilly
AU - Sibelli, Alice
AU - Holland, Rachel
AU - Hughes, Stephanie
AU - Windgassen, Sula
AU - Goldsmith, Kimberley
AU - Coleman, Nicholas
AU - Logan, Robert
AU - Chalder, Trudie
AU - Moss-Morris, Rona
N1 - 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).
PY - 2021/7/6
Y1 - 2021/7/6
N2 - 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).
AB - 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).
KW - Irritable Bowel Syndrome
KW - Cognitive Behavioural Approach
KW - economic evaluation
KW - cost-effectiveness
UR - http://www.scopus.com/inward/record.url?scp=85109363073&partnerID=8YFLogxK
U2 - 10.1186/s12876-021-01848-9
DO - 10.1186/s12876-021-01848-9
M3 - Article
SN - 1471-230X
VL - 21
JO - BMC GASTROENTEROLOGY
JF - BMC GASTROENTEROLOGY
IS - 1
M1 - 276
ER -