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Hannah K, Marie K, Olaf H, Stephan B, Andreas D, Wilson Michael L, Till B, Peter D. The global economic burden of health anxiety/hypochondriasis- a systematic review. BMC Public Health 2023; 23:2237. [PMID: 37957598 PMCID: PMC10644595 DOI: 10.1186/s12889-023-17159-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Recent studies have shown a lifetime prevalence of 5.7% for health anxiety/hypochondriasis resulting in increased healthcare service utilisation and disability as consequences. To the best of our knowledge, there has been no systematic review examining the global costs of hypochondriasis, encompassing both direct and indirect costs. Our objective was to synthesize the available evidence on the economic burden of health anxiety and hypochondriasis to identify research gaps and provide guidance and insights for policymakers and future research. METHODS A systematic literature search was conducted using PubMed, Web of Science, PsycInfo, EconLit, IBSS and Google Scholar without any time limit, up until April 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this search and the following article selection process. The included studies were systematically analysed and summarized using a predefined data extraction sheet. RESULTS Of the 3044 articles identified; 10 publications met our inclusion criteria. The results displayed significant variance in the overall costs listed among the studies. The reported economic burden of hypochondriasis ranged from 857.19 to 21137.55 US$ per capita per year. Most of the investigated costs were direct costs, whereas the assessment of indirect costs was strongly underrepresented. CONCLUSION This systematic review suggests that existing studies underestimate the costs of hypochondriasis due to missing information on indirect costs. Furthermore, there is no uniform data collection of the costs and definition of the disease, so that the few existing data are not comparable and difficult to evaluate. There is a need for standardised data collection and definition of hypochondriasis in future studies to identify major cost drivers as potential target point for interventions.
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Affiliation(s)
- Kawka Hannah
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany.
| | - Kurtz Marie
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Horstick Olaf
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Brenner Stephan
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Deckert Andreas
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Lowery Wilson Michael
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Baernighausen Till
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Dambach Peter
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
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González-Flores CJ, Garcia-Garcia G, Lerma C, Guzmán-Saldaña RME, Lerma A. Effect of Cognitive Behavioral Intervention Combined with the Resilience Model to Decrease Depression and Anxiety Symptoms and Increase the Quality of Life in ESRD Patients Treated with Hemodialysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5981. [PMID: 37297585 PMCID: PMC10252699 DOI: 10.3390/ijerph20115981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
The aim of this study was to compare the effect of cognitive behavioral intervention (CBI) combined with the resilience model (CBI + R) vs CBI alone on depression symptoms, anxiety symptoms, and quality of life of end-stage renal disease (ESRD) patients undergoing hemodialysis replacement therapy. METHOD Fifty-three subjects were randomly assigned to one of two treatment groups. The control group (n = 25) was provided with treatment strategies based on a cognitive behavioral approach, while the experimental group (n = 28) were given the same techniques plus resilience model strategies. Five psychological instruments were applied: Beck Depression Inventory, Beck Anxiety Inventory, Mexican Resilience Scale, cognitive distortions scale, and the Kidney Disease related Quality of Life questionnaire. Participants were assessed at baseline (before treatment), eight weeks later (end of treatment), and four weeks after the end of treatment (follow up). The results were analyzed by ANOVA for repeated measures with a Bonferroni-adjusted test method, with p < 0.05 considered significant. RESULTS The experimental group had significant differences in total and somatic depression as well as differences in the dimensions of cognitive distortions and a significant increase in the dimensions of resilience. The control group had significant differences in all variables but showed lower scores in the evaluated times. CONCLUSIONS The resilience model strengthens and enhances the effectiveness of the cognitive behavioral approach to reduce symptoms of depression and anxiety in patients with ESRD.
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Affiliation(s)
| | - Guillermo Garcia-Garcia
- Nephrology Department, Civil Hospital de Guadalajara Fray Antonio Alcalde, Guadalajara 44280, Mexico;
| | - Claudia Lerma
- Instituto Nacional de Cardiología Ignacio Chávez, México City 14080, Mexico;
| | | | - Abel Lerma
- Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, San Juan Tilcuautla 42160, Mexico;
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Flygare O, Andersson E, Glimsdal G, Mataix-Cols D, Pascal D, Rück C, Enander J. Cost-effectiveness of internet-delivered cognitive behaviour therapy for body dysmorphic disorder: Results from a randomised controlled trial. Internet Interv 2023; 31:100604. [PMID: 36756354 PMCID: PMC9900508 DOI: 10.1016/j.invent.2023.100604] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/05/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To evaluate the cost-effectiveness of internet-delivered cognitive behaviour therapy for body dysmorphic disorder (BDD-NET). DESIGN Secondary cost-effectiveness analysis from a randomised controlled trial on BDD-NET versus online supportive psychotherapy. SETTING Academic medical center. PARTICIPANTS Self-referred adult participants with a primary diagnosis of body dysmorphic disorder and a score of 20 or higher on the modified Yale-Brown Obsessive Compulsive Scale for BDD (n = 94). Patients receiving concurrent psychotropic drug treatment were included if the dose had been stable for at least two months. INTERVENTIONS Participants received either BDD-NET (n = 47) or online supportive psychotherapy (n = 47) for 12 weeks. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were cost-effectiveness and cost-utility from a societal perspective, using remission status from a diagnostic interview and quality-adjusted life years (QALY), respectively. Secondary outcome measures were cost-effectiveness and cost-utility from a health care perspective and the clinic's perspective. RESULTS Compared to supportive psychotherapy, BDD-NET produced one additional remission for an average societal cost of $4132. The cost-utility analysis showed that BDD-NET generated one QALY to an average cost of $14,319 from a societal perspective. CONCLUSIONS BDD-NET is a cost-effective treatment for body dysmorphic disorder, compared to online supportive psychotherapy. The efficacy and cost-effectiveness of BDD-NET should next be directly compared to in-person cognitive behaviour therapy. TRIAL REGISTRATION NCT02010619.
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Affiliation(s)
- Oskar Flygare
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden,Corresponding author at: M46, Karolinska University Hospital, SE-141 86 Huddinge, Sweden.
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Gjermund Glimsdal
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Diana Pascal
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Jesper Enander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden
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Risør BW, Frydendal DH, Villemoes MK, Nielsen CP, Rask CU, Frostholm L. Cost Effectiveness of Internet-Delivered Acceptance and Commitment Therapy for Patients with Severe Health Anxiety: A Randomised Controlled Trial. PHARMACOECONOMICS - OPEN 2022; 6:179-192. [PMID: 34997899 PMCID: PMC8864054 DOI: 10.1007/s41669-021-00319-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Health anxiety is a prevalent and debilitating disorder associated with extensive use of healthcare services and reduced quality of life (QoL). Regional variability in specialised clinics or specialist healthcare providers limits access to evidence-based treatment, which may be overcome by internet-delivered Acceptance and Commitment Therapy (iACT). OBJECTIVE This study investigated the cost effectiveness of iACT for severe health anxiety in adults. METHODS Based on a Danish randomised controlled trial (March 2016-March 2017), the economic evaluation compared costs and effects between iACT and an active control condition (iFORUM). Effectiveness was measured using self-report questionnaires. The cost analysis applied a societal perspective. Resource use and healthcare costs were extracted from the Danish National Registries. Linear regression analysis was applied using change in costs/effectiveness outcomes as the dependant variable. Time, group, and interaction between time and group were independent variables. The primary outcome was the proportion of clinically significant improvements, defined as a ≥ 25% reduction in two measures of health anxiety. The probability of cost effectiveness was presented in a cost-effectiveness acceptability curve for a range of threshold values for willingness to pay. RESULTS No significant differences were detected in healthcare costs between groups; however, the iACT group significantly improved in all effectiveness outcomes. The economic analysis showed that, from the healthcare perspective, iACT was associated with an incremental cost-effectiveness ratio of €33 per additional case of clinically significant improvement compared with iFORUM and that, from the societal perspective, iACT dominated iFORUM because it was more effective and less expensive. CONCLUSIONS We found no statistically significant differences in costs between groups; however, iACT for severe health anxiety may be cost effective, as evidenced by significant differences in effect. TRIAL REGISTRY NUMBER Clinicaltrials.gov, no. NCT02735434.
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Affiliation(s)
- Bettina Wulff Risør
- DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark.
| | - Ditte Hoffmann Frydendal
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, University City 21 and 23, 8000, Aarhus C, Denmark
| | | | - Camilla Palmhøj Nielsen
- DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul Jensens Boulevard 175, Entrance K, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, University City 21 and 23, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Gega L, Jankovic D, Saramago P, Marshall D, Dawson S, Brabyn S, Nikolaidis GF, Melton H, Churchill R, Bojke L. Digital interventions in mental health: evidence syntheses and economic modelling. Health Technol Assess 2022; 26:1-182. [PMID: 35048909 DOI: 10.3310/rcti6942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Economic evaluations provide evidence on whether or not digital interventions offer value for money, based on their costs and outcomes relative to the costs and outcomes of alternatives. OBJECTIVES (1) Evaluate and summarise published economic studies about digital interventions across different technologies, therapies, comparators and mental health conditions; (2) synthesise clinical evidence about digital interventions for an exemplar mental health condition; (3) construct an economic model for the same exemplar mental health condition using the previously synthesised clinical evidence; and (4) consult with stakeholders about how they understand and assess the value of digital interventions. METHODS We completed four work packages: (1) a systematic review and quality assessment of economic studies about digital interventions; (2) a systematic review and network meta-analysis of randomised controlled trials on digital interventions for generalised anxiety disorder; (3) an economic model and value-of-information analysis on digital interventions for generalised anxiety disorder; and (4) a series of knowledge exchange face-to-face and digital seminars with stakeholders. RESULTS In work package 1, we reviewed 76 economic evaluations: 11 economic models and 65 within-trial analyses. Although the results of the studies are not directly comparable because they used different methods, the overall picture suggests that digital interventions are likely to be cost-effective, compared with no intervention and non-therapeutic controls, whereas the value of digital interventions compared with face-to-face therapy or printed manuals is unclear. In work package 2, we carried out two network meta-analyses of 20 randomised controlled trials of digital interventions for generalised anxiety disorder with a total of 2350 participants. The results were used to inform our economic model, but when considered on their own they were inconclusive because of the very wide confidence intervals. In work package 3, our decision-analytic model found that digital interventions for generalised anxiety disorder were associated with lower net monetary benefit than medication and face-to-face therapy, but greater net monetary benefit than non-therapeutic controls and no intervention. Value for money was driven by clinical outcomes rather than by intervention costs, and a value-of-information analysis suggested that uncertainty in the treatment effect had the greatest value (£12.9B). In work package 4, stakeholders identified several areas of benefits and costs of digital interventions that are important to them, including safety, sustainability and reducing waiting times. Four factors may influence their decisions to use digital interventions, other than costs and outcomes: increasing patient choice, reaching underserved populations, enabling continuous care and accepting the 'inevitability of going digital'. LIMITATIONS There was substantial uncertainty around effect estimates of digital interventions compared with alternatives. This uncertainty was driven by the small number of studies informing most comparisons, the small samples in some of these studies and the studies' high risk of bias. CONCLUSIONS Digital interventions may offer good value for money as an alternative to 'doing nothing' or 'doing something non-therapeutic' (e.g. monitoring or having a general discussion), but their added value compared with medication, face-to-face therapy and printed manuals is uncertain. Clinical outcomes rather than intervention costs drive 'value for money'. FUTURE WORK There is a need to develop digital interventions that are more effective, rather than just cheaper, than their alternatives. STUDY REGISTRATION This study is registered as PROSPERO CRD42018105837. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lina Gega
- Department of Health and Social Care Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK.,Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Dina Jankovic
- Centre for Health Economics, University of York, York, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - David Marshall
- Centre for Reviews & Dissemination, University of York, York, UK
| | - Sarah Dawson
- Common Mental Disorders Group, Cochrane Collaboration, University of York, York, UK.,Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Sally Brabyn
- Department of Health and Social Care Sciences, University of York, York, UK
| | | | - Hollie Melton
- Centre for Reviews & Dissemination, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews & Dissemination, University of York, York, UK.,Common Mental Disorders Group, Cochrane Collaboration, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
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6
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Mitchell LM, Joshi U, Patel V, Lu C, Naslund JA. Economic Evaluations of Internet-Based Psychological Interventions for Anxiety Disorders and Depression: A Systematic Review. J Affect Disord 2021; 284:157-182. [PMID: 33601245 PMCID: PMC8008508 DOI: 10.1016/j.jad.2021.01.092] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Internet-based interventions show clinical effectiveness for treating anxiety disorders and depression and could make mental healthcare more affordable. METHODS We searched databases including PubMed; EMBASE; Cochrane Central; PsychINFO; CINAHL; EconLit; and Web of Science from January 1, 2000 to August 21, 2020. Inclusion criteria were: 1) pertained to the treatment or prevention of anxiety disorders or depression; 2) evaluated the use of an internet-delivered psychological intervention; 3) recruited participants; and 4) reported costs or cost-effectiveness. RESULTS Of the 6,069 articles identified, 33 targeted anxiety (N=13) and depression (n=20) and met final inclusion criteria. All studies were from high-income countries. The control conditions and cost components included were heterogeneous. Only eight studies reported costs of developing the intervention. Of 27 studies that made a conclusion about cost-effectiveness, 81% of interventions were cost-effective. The quality of studies included was high based on a quality assessment checklist of economic evaluations, although many studies did not include definitions of cost components or differentiate between patient-side and system-level costs. LIMITATIONS Studies varied in methodology, making conclusions about cost-effectiveness difficult. The generalizability of these results is unclear as studies were clustered in a small number of high-income countries and costs vary over time and between regions. CONCLUSIONS Internet-delivered interventions appeared to be cost-effective although control conditions and cost component reporting were variable. We propose a checklist of cost components for future cost analyses to better compare intervention costs. More research is needed to describe development costs, cost-effectiveness in low-resource settings, and cost-effectiveness of newer technologies.
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Affiliation(s)
- Lauren M Mitchell
- Department of Internal Medicine, New York Presbyterian Hospital - Weill Cornell, New York, NY, USA.
| | | | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA,Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA,Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Jankovic D, Bojke L, Marshall D, Saramago Goncalves P, Churchill R, Melton H, Brabyn S, Gega L. Systematic Review and Critique of Methods for Economic Evaluation of Digital Mental Health Interventions. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:17-27. [PMID: 32803521 DOI: 10.1007/s40258-020-00607-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Investment in digital interventions for mental health conditions is growing rapidly, offering the potential to elevate systems that are currently overstretched. Despite a growing literature on economic evaluation of digital mental health interventions (DMHIs), including several systematic reviews, there is no conclusive evidence regarding their cost-effectiveness. This paper reviews the methodology used to determine their cost-effectiveness and assesses whether this meets the requirements for decision-making. In doing so we consider the challenges specific to the economic evaluation of DMHIs, and identify where consensus and possible further research is warranted. METHODS A systematic review was conducted to identify all economic evaluations of DMHIs published between 1997 and December 2018. The searches included databases of published and unpublished research, reference lists and citations of all included studies, forward citations on all identified protocols and conference abstracts, and contacting authors researchers in the field. The identified studies were critiqued against a published set of requirements for decision-making in healthcare, identifying methodological challenges and areas where consensus is required. RESULTS The review identified 67 papers evaluating DMHIs. The majority of the evaluations were conducted alongside trials, failing to capture all relevant available evidence and comparators, and long-term impact of mental health disorders. The identified interventions are complex and heterogeneous. As a result, there are a number of challenges specific to their evaluation, including estimation of all costs and outcomes, conditional on analysis viewpoint, and identification of relevant comparators. A taxonomy for DMHIs may be required to inform what interventions can reasonably be pooled and compared. CONCLUSIONS This study represents the first attempt to understand the appropriateness of the methodologies used to evaluate the value for money of DMHIs, helping work towards consensus and methods' harmonisation on these complex interventions.
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Affiliation(s)
- Dina Jankovic
- Centre for Health Economics, The University of York, Alcuin College, A Block, York, YO10 5DD, UK.
| | - Laura Bojke
- Centre for Health Economics, The University of York, Alcuin College, A Block, York, YO10 5DD, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Pedro Saramago Goncalves
- Centre for Health Economics, The University of York, Alcuin College, A Block, York, YO10 5DD, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Hollie Melton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, York, UK
| | - Lina Gega
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
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8
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Axelsson E, Hesser H, Andersson E, Ljótsson B, Hedman-Lagerlöf E. Mediators of treatment effect in minimal-contact cognitive behaviour therapy for severe health anxiety: A theory-driven analysis based on a randomised controlled trial. J Anxiety Disord 2020; 69:102172. [PMID: 31864217 DOI: 10.1016/j.janxdis.2019.102172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/25/2019] [Accepted: 12/05/2019] [Indexed: 02/03/2023]
Abstract
Cognitive behaviour therapy (CBT) is efficacious for severe health anxiety, but little is known about mechanisms. We analysed putative mediators of change based on 13 weekly assessments in a randomised controlled trial (N = 132) of exposure-based minimal-contact CBT (guided Internet-delivered CBT, unguided Internet-delivered CBT and bibliotherapy) vs. a waitlist control for severe health anxiety. We hypothesised that the effect of CBT on health anxiety would be mediated by non-reactivity to inner experiences, health anxiety behaviours and perceived competence. We also explored somatosensory amplification. In parallel process growth models, non-reactivity, health anxiety behaviours and perceived competence - but not somatosensory amplification - were influenced by CBT and associated with health anxiety. Random intercepts cross-lagged panel models were used to study within-individual ordering of change. None of the putative mediators systematically predicted subsequent changes in health anxiety. Rather, changes in health anxiety predicted subsequent changes in all putative mediators. In summary, CBT influenced health anxiety behaviours, non-reactivity to inner experiences and perceived competence, and these variables were associated with the outcome. However, their role as mediators was not corroborated because we found no evidence that changes in these variables predicted subsequent changes in health anxiety. We encourage further research into mediators of CBT for health anxiety.
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Affiliation(s)
- Erland Axelsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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9
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Axelsson E, Hedman-Lagerlöf E. Cognitive behavior therapy for health anxiety: systematic review and meta-analysis of clinical efficacy and health economic outcomes. Expert Rev Pharmacoecon Outcomes Res 2019; 19:663-676. [DOI: 10.1080/14737167.2019.1703182] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Erland Axelsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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10
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Lindsäter E, Axelsson E, Salomonsson S, Santoft F, Ljótsson B, Åkerstedt T, Lekander M, Hedman-Lagerlöf E. Cost-Effectiveness of Therapist-Guided Internet-Based Cognitive Behavioral Therapy for Stress-Related Disorders: Secondary Analysis of a Randomized Controlled Trial. J Med Internet Res 2019; 21:e14675. [PMID: 31586370 PMCID: PMC6788336 DOI: 10.2196/14675] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/14/2019] [Accepted: 07/27/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Stress-related disorders are associated with significant suffering, functional impairment, and high societal costs. Internet-based cognitive behavioral therapy (ICBT) is a promising treatment for stress-related disorders but has so far not been subjected to health economic evaluation. OBJECTIVE The objective of this study was to evaluate the cost-effectiveness and cost-utility of ICBT for patients with stress-related disorders in the form of adjustment disorder (AD) or exhaustion disorder (ED). We hypothesized that ICBT, compared with a waitlist control (WLC) group, would generate improvements at low net costs, thereby making it cost-effective. METHODS Health economic data were obtained in tandem with a randomized controlled trial of a 12-week ICBT in which patients (N=100) were randomized to an ICBT (n=50) or a WLC (n=50) group. Health outcomes and costs were surveyed pre- and posttreatment. We calculated incremental cost-effectiveness ratios (ICERs) based on remission rates and incremental cost-utility ratios (ICURs) based on health-related quality of life. Bootstrap sampling was used to assess the uncertainty of our results. RESULTS The ICER indicated that the most likely scenario was that ICBT led to higher remission rates compared with the WLC and was associated with slightly larger reductions in costs from pre- to posttreatment. ICBT had a 60% probability of being cost-effective at a willingness to pay (WTP) of US $0 and a 96% probability of being cost-effective at a WTP of US $1000. The ICUR indicated that ICBT also led to improvements in quality of life at no net societal cost. Sensitivity analyses supported the robustness of our results. CONCLUSIONS The results suggest that ICBT is a cost-effective treatment for patients suffering from AD or ED. Compared with no treatment, ICBT for these patients yields large effects at no or minimal societal net costs. TRIAL REGISTRATION ClinicalTrials.gov NCT02540317; https://clinicaltrials.gov/ct2/show/NCT02540317.
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Affiliation(s)
- Elin Lindsäter
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sigrid Salomonsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Santoft
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Åkerstedt
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Mats Lekander
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden.,Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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11
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Robinson NL, Cottier TV, Kavanagh DJ. Psychosocial Health Interventions by Social Robots: Systematic Review of Randomized Controlled Trials. J Med Internet Res 2019; 21:e13203. [PMID: 31094357 PMCID: PMC6533873 DOI: 10.2196/13203] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/22/2019] [Accepted: 04/09/2019] [Indexed: 01/06/2023] Open
Abstract
Background Social robots that can communicate and interact with people offer exciting opportunities for improved health care access and outcomes. However, evidence from randomized controlled trials (RCTs) on health or well-being outcomes has not yet been clearly synthesized across all health domains where social robots have been tested. Objective This study aimed to undertake a systematic review examining current evidence from RCTs on the effects of psychosocial interventions by social robots on health or well-being. Methods Medline, PsycInfo, ScienceDirect, Scopus, and Engineering Village searches across all years in the English language were conducted and supplemented by forward and backward searches. The included papers reported RCTs that assessed changes in health or well-being from interactions with a social robot across at least 2 measurement occasions. Results Out of 408 extracted records, 27 trials met the inclusion criteria: 6 in child health or well-being, 9 in children with autism spectrum disorder, and 12 with older adults. No trials on adolescents, young adults, or other problem areas were identified, and no studies had interventions where robots spontaneously modified verbal responses based on speech by participants. Most trials were small (total N=5 to 415; median=34), only 6 (22%) reported any follow-up outcomes (2 to 12 weeks; median=3.5) and a single-blind assessment was reported in 8 (31%). More recent trials tended to have greater methodological quality. All papers reported some positive outcomes from robotic interventions, although most trials had some measures that showed no difference or favored alternate treatments. Conclusions Controlled research on social robots is at an early stage, as is the current range of their applications to health care. Research on social robot interventions in clinical and health settings needs to transition from exploratory investigations to include large-scale controlled trials with sophisticated methodology, to increase confidence in their efficacy.
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Affiliation(s)
- Nicole Lee Robinson
- Australian Centre for Robotic Vision, Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia
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12
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Morriss R, Patel S, Malins S, Guo B, Higton F, James M, Wu M, Brown P, Boycott N, Kaylor-Hughes C, Morris M, Rowley E, Simpson J, Smart D, Stubley M, Kai J, Tyrer H. Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: a multicentre randomised controlled trial. BMC Med 2019; 17:16. [PMID: 30670044 PMCID: PMC6343350 DOI: 10.1186/s12916-019-1253-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/07/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND It is challenging to engage repeat users of unscheduled healthcare with severe health anxiety in psychological help and high service costs are incurred. We investigated whether clinical and economic outcomes were improved by offering remote cognitive behaviour therapy (RCBT) using videoconferencing or telephone compared to treatment as usual (TAU). METHODS A single-blind, parallel group, multicentre randomised controlled trial was undertaken in primary and general hospital care. Participants were aged ≥18 years with ≥2 unscheduled healthcare contacts within 12 months and scored >18 on the Health Anxiety Inventory. Randomisation to RCBT or TAU was stratified by site, with allocation conveyed to a trial administrator, research assessors masked to outcome. Data were collected at baseline, 3, 6, 9 and 12 months. The primary outcome was change in HAI score from baseline to six months on an intention-to-treat basis. Secondary outcomes were generalised anxiety, depression, physical symptoms, function and overall health. Health economics analysis was conducted from a health service and societal perspective. RESULTS Of the 524 patients who were referred and assessed for trial eligibility, 470 were eligible and 156 (33%) were recruited; 78 were randomised to TAU and 78 to RCBT. Compared to TAU, RCBT significantly reduced health anxiety at six months, maintained to 9 and 12 months (mean change difference HAI -2.81; 95% CI -5.11 to -0.50; P = 0.017). Generalised anxiety, depression and overall health was significantly improved at 12 months, but there was no significant change in physical symptoms or function. RCBT was strictly dominant with a net monetary benefit of £3,164 per participant at a willingness to pay threshold of £30,000. No treatment-related adverse events were reported in either group. CONCLUSIONS RCBT may reduce health anxiety, general anxiety and depression and improve overall health, with considerable reductions in health and informal care costs in repeat users of unscheduled care with severe health anxiety who have previously been difficult to engage in psychological treatment. RCBT may be an easy-to-implement intervention to improve clinical outcome and save costs in one group of repeat users of unscheduled care. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov on 19 Nov 2014 with reference number NCT02298036.
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Affiliation(s)
- Richard Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.
| | - Shireen Patel
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Sam Malins
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Boliang Guo
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Fred Higton
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Marilyn James
- Division of Rehabilitation and Ageing, University of Nottingham, School of Medicine, Nottingham, NG7 2UH, UK
| | - Mengjun Wu
- Division of Rehabilitation and Ageing, University of Nottingham, School of Medicine, Nottingham, NG7 2UH, UK
| | - Paula Brown
- Nottinghamshire Healthcare NHS Foundation Trust, Duncan MacMillan House, Porchester Road, Nottingham, NG3 6AA, UK
| | - Naomi Boycott
- Nottinghamshire Healthcare NHS Foundation Trust, Duncan MacMillan House, Porchester Road, Nottingham, NG3 6AA, UK
| | - Catherine Kaylor-Hughes
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Martin Morris
- Leicestershire Partnership NHS Trust, Plaza, Riverside House Bridge Park, Bridge Park Road, Thurmaston, Leicester, LE4 8PQ, UK
| | - Emma Rowley
- Business School, University of Nottingham, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Jayne Simpson
- Nottinghamshire Healthcare NHS Foundation Trust, Duncan MacMillan House, Porchester Road, Nottingham, NG3 6AA, UK
| | - David Smart
- Leicester Terrace Health Centre, Adelaide St, Northampton, NN2 6AL, UK
| | - Michelle Stubley
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Joe Kai
- Division of Primary Care, University of Nottingham, School of Medicine, Nottingham, NG7 2UH, UK
| | - Helen Tyrer
- Department of Psychiatry, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
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