Cost effectiveness of internet-based cognitive behaviour therapy and behavioural stress management for severe health anxiety
Open accessAbstract
Objectives: Internet-delivered exposure-based cognitive behaviour therapy (ICBT) has been shown to be effective in the treatment of severe health anxiety. The health economic effects of the treatment have, however, been insufficiently studied and no prior study has investigated the effect of ICBT compared with an active psychological treatment. The aim of the present study was to investigate the cost effectiveness of ICBT compared with internet-delivered behavioural stress management (IBSM) for adults with severe health anxiety defined as Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) hypochondriasis. ICBT was hypothesised to be the more cost-effective treatment. Setting: This was a cost-effectiveness study within the context of a randomised controlled trial conducted in a primary care/university setting. Participants from all of Sweden could apply to participate. Participants: Self-referred adults (N=158) with a principal diagnosis of DSM-IV hypochondriasis, of whom 151 (96%) provided baseline and post-treatment data. Interventions: ICBT or IBSM for 12 weeks. Primary and secondary measures: The primary outcome was the Health Anxiety Inventory. The secondary outcome was the EQ-5D. Other secondary measures were used in the main outcome study but were not relevant for the present health economic analysis. Results: Both treatments led to significant reductions in gross total costs, costs of healthcare visits, direct non-medical costs and costs of domestic work cutback (p=0.000–0.035). The incremental cost-effectiveness ratio (ICER) indicated that the cost of one additional case of clinically significant improvement in ICBT compared with IBSM was $2214. The cost-utility ICER, that is, the cost of one additional quality-adjusted life year, was estimated to be $10 000. Conclusions: ICBT is a cost-effective treatment compared with IBSM and treatment costs are offset by societal net cost reductions in a short time. A cost-benefit analysis speaks for ICBT to play an important role in increasing access to effective treatment for severe health anxiety. Trial registration number: NCT01673035; Results.
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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 [28]
The Methods (Procedures; page unavailable) confirm a cost-utility analysis based on incremental QALYs measured with the EQ-5D. But the Results (Cost-utility analysis; page unavailable) estimate $10,000 per additional QALY and say internet-based CBT most likely produced larger health-related quality-of-life improvements than behavioural stress management, at a larger cost. This supports the QALY-analysis component but not the characterization of its result as less conclusive or showing limited quality-of-life benefit. (LLM, conf=0.84)
Experimental — accuracy not yet measuredUsing 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 [28]
The Methods identify the Health Anxiety Inventory as the primary outcome, and the Discussion concludes that internet-based CBT was cost-effective for severe health anxiety. The Discussion also describes earlier face-to-face CBT studies as consistent with that finding, but says this study had no face-to-face CBT arm. It therefore does not establish cost-effectiveness regardless of delivery format. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThese findings, as well as the probability of iACT being cost effective interpreted through CEACs, are supported by previous studies reporting similar results using reduction of health anxiety as the cost-effectiveness outcome.
“These findings, as well as the probability of iACT being cost effective interpreted through CEACs, are supported by previous studies reporting similar results using reduction of health anxiety as the cost-effectiveness outcome [27, 28].”
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 [28]
Recent larger clinical trials have found significant cost reductions associated with CBT interventions.
“Recent larger clinical trials have found significant cost reductions associated with CBT interventions [28, 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 [28]
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- Authors
- Hedman, E., Andersson, E., Ljótsson, B., Axelsson, E., & Lekander, M.
- Affiliations
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
- Karolinska Institutet (SE)
- Stockholm University (SE)
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2016-04
- Volume
- 6
- Issue
- 4
- Pages
- e009327
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC4854011
- OpenAlex
- W2343313084
- Cited by
- 49
- References
- 33
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 4 · 2022: 14 · 2021: 3 · 2020: 4 · 2019: 5 · 2018: 8 · 2017: 3
- FWCI
- 8.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Karolinska Institutet
- Stockholms Läns Landsting
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- internet-based cognitive behavioral therapy, health anxiety, cost-effectiveness, internet-based psychological treatment, quality-adjusted life years, health care costs, primary care
- MeSH terms
- Adult, Anxiety, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Primary Health Care, Prospective Studies, Psychiatric Status Rating Scales, Severity of Illness Index, Sweden, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome, Quality-Adjusted Life Years, Internet, Diagnostic and Statistical Manual of Mental Disorders, Self Report
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