Cost-effectiveness and long-term follow-up of three forms of minimal-contact cognitive behaviour therapy for severe health anxiety: Results from a randomised controlled trial
Abstract
Strategies to increase the availability of cognitive behaviour therapy (CBT) for severe health anxiety (SHA) are needed, and this study investigated the cost-effectiveness and long-term efficacy of three forms of minimal-contact CBT for SHA. We hypothesised that therapist-guided internet CBT (G-ICBT), unguided internet CBT (U-ICBT), and cognitive behavioural bibliotherapy (BIB-CBT) would all be more cost-effective than a waiting-list condition (WLC), as assessed over the main phase of the trial. We also hypothesised that improvements would remain stable up to one-year follow-up. Adults (N = 132) with principal SHA were randomised to 12 weeks of G-ICBT, U-ICBT, BIB-CBT, or WLC. The primary measure of cost-effectiveness was the incremental cost-effectiveness ratio, or the between-group difference in per capita costs divided by the between-group difference in proportion of participants in remission. The Health anxiety inventory (HAI) was the primary efficacy outcome. G-ICBT, U-ICBT, and BIB-CBT were more cost-effective than the WLC. Over the follow-up period, the G-ICBT and BIB-CBT groups made further improvements in health anxiety, whereas the U-ICBT group did not change. As expected, all three treatments were cost-effective with persistent long-term effects. CBT without therapist support appears to be a valuable alternative to G-ICBT for scaling up treatment for SHA.
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Cost-utility analyses using quality-adjusted life-years as the primary outcome measure were less conclusive, with CBT showing limited benefit for health-related quality of life.
“In contrast, cost-utility analyses using quality-adjusted life-years (QALYs) as the primary outcome measure were less conclusive, with CBT showing limited benefit for health-related QoL [26–29].”
From Cost Effectiveness of Internet-Delivered Acceptance and Commitment Therapy for Patients with Severe Health Anxiety: A Randomised Controlled Trial (2022) · cites this paper as [26]
Using the Health Anxiety Inventory as the outcome measure, CBT was found to be cost effective regardless of the form of delivery.
“Using the Health Anxiety Inventory (HAI) as the outcome measure, CBT was found to be cost effective regardless of the form of delivery.”
From Cost Effectiveness of Internet-Delivered Acceptance and Commitment Therapy for Patients with Severe Health Anxiety: A Randomised Controlled Trial (2022) · cites this paper as [26]
These results are similar to previous iCBT studies that reported the same tendency but found no statistically significant differences in costs between groups at follow-up.
“These results are similar to those from the previous iCBT studies [16, 26, 27, 30] that reported the same tendency but found no statistically significant differences in costs between groups at follow-up”
From Cost Effectiveness of Internet-Delivered Acceptance and Commitment Therapy for Patients with Severe Health Anxiety: A Randomised Controlled Trial (2022) · cites this paper as [26]
The results were in line with Axelsson et al., who used cases in remission as an effectiveness measurement and found a slightly higher ICER for therapist-guided iCBT from the healthcare perspective, whereas the intervention was found to be dominant from the societal perspective.
“our results were in line with those of Axelsson et al. [26], who used cases in remission as an effectiveness measurement and found a slightly higher ICER for therapist-guided iCBT from the healthcare perspective, whereas the intervention, similar to our findings, was found to be dominant from the societal perspective.”
From Cost Effectiveness of Internet-Delivered Acceptance and Commitment Therapy for Patients with Severe Health Anxiety: A Randomised Controlled Trial (2022) · cites this paper as [26]
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- Authors
- Axelsson, E., Andersson, E., Ljótsson, B., & Hedman-Lagerlöf, E.
- Affiliations
- Karolinska Institutet (SE)
- Corresponding author
- Axelsson, Erland
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 107
- Pages
- 95-105
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2808129767
- Cited by
- 19
- References
- 65
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 4 · 2022: 4 · 2021: 1 · 2020: 1 · 2019: 6
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Karolinska Institutet
- Kommunfullmäktige, Stockholms Stad
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- health anxiety, cognitive behavioral therapy, bibliotherapy, cost-effectiveness, long-term follow-up, remission
- MeSH terms
- Adult, Aged, Anxiety Disorders, Bibliotherapy, Cost-Benefit Analysis, Female, Follow-Up Studies, Humans, Male, Middle Aged, Waiting Lists, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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