Cost-effectiveness analysis of telephone cognitive-behaviour therapy for adolescents with obsessive-compulsive disorder
Open accessAbstract
Background: Telephone cognitive–behaviour therapy (TCBT) may be a cost-effective method for improving access to evidence-based treatment for obsessive–compulsive disorder (OCD) in young people. Aims: Economic evaluation of TCBT compared with face-to-face CBT for OCD in young people. Method: Randomised non-inferiority trial comparing TCBT with face-to-face CBT for 72 young people (aged 11 to 18) with a diagnosis of OCD. Cost-effectiveness at 12-month follow-up was explored in terms of the primary clinical outcome (Children's Yale-Brown Obsessive-Compulsive Scale, CY-BOCS) and quality-adjusted life-years (QALYs) (trial registration: ISRCTN27070832). Results: Total health and social care costs were higher for face-to-face CBT (mean total cost £2965, s.d. = £1548) than TCBT (mean total cost £2475, s.d. = £1024) but this difference was non-significant (P = 0.118). There were no significant between-group differences in QALYs or the CY-BOCS and there was strong evidence to support the clinical non-inferiority of TCBT. Cost-effectiveness analysis suggests a 74% probability that face-to-face CBT is cost-effective compared with TCBT in terms of QALYs, but the result was less clear in terms of CY-BOCS, with TCBT being the preferred option at low levels of willingness to pay and the probability of either intervention being cost-effective at higher levels of willingness to pay being around 50%. Conclusions: Although cost-effectiveness of TCBT was sensitive to the outcome measure used, TCBT should be considered a clinically non-inferior alternative when access to standard clinic-based CBT is limited, or when patient preference is expressed. Declaration of interest: D.M.-C. reports research grants from the Swedish Research Council (Vetenskapsrådet), the Swedish Research Council for Health, working life and welfare (Forte), the US National Institute of Mental Health (NIMH), the UK National Institute of Health Research (NIHR), as well as royalties from Wolters Kluwer Health and Elsevier, all unrelated to the submitted work.
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Other evidence for specific interventions targeting disorders that occur mainly in young people (such as depressive or eating disorders) have also been found to be highly cost-effective.
“Other evidence for specific interventions targeting disorders that occur mainly in young people (such as depressive or eating disorders) have also been found to be highly cost-effective. 430-432”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [432]
The Discussion (Policy implications; page unavailable) says this study found no evidence that telephone CBT was cost-effective compared with face-to-face CBT for young people with OCD, particularly when measured by QALYs. It does not report a highly cost-effective intervention for depression or an eating disorder. (LLM, conf=0.86)
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Cites
Improving access to psychological therapy: initial evaluation of two UK demonstration sites
Clark, D. M., Layard, R., Smithies, R., Richards, D. A., Suckling, R., & Wright, B. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.07.010 · Cited by 599 · see citing works
Mataix‐Cols, D., de la Cruz, L. F., Nordsletten, A. E., Lenhard, F., Isomura, K., & Simpson, H. B. (2016) · World Psychiatry · doi:10.1002/wps.20299 · Cited by 386 · see citing works
Self-citationKaltenthaler, E., Brazier, J., De Nigris, E., Tumur, I., Ferriter, M., Beverley, C., Parry, G., Rooney, G., & Sutcliffe, P. (2006) · Health Technology Assessment · doi:10.3310/hta10330 · Cited by 357 · see citing works
Lovell, K., & Richards, D. (2000) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465800004070 · Cited by 216 · see citing works
Self-citationTurner, C. M., Mataix-Cols, D., Lovell, K., Krebs, G., Lang, K., Byford, S., & Heyman, I. (2014) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2014.09.012 · Cited by 111 · see citing works
Self-citationHammond, G. C., Croudace, T. J., Radhakrishnan, M., Lafortune, L., Watson, A., McMillan-Shields, F., & Jones, P. B. (2012) · PLoS ONE · doi:10.1371/journal.pone.0042916 · Cited by 79 · see citing works
Flagged first, then by citations
Research works printed but not linked: 27
- [1]Heyman I, Fombonne E, Simmons H, Ford T, Meltzer H, Goodman R. Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health. Br J Psychiatry 2001; 179: 324–9. 11581112
- [2]Freeman JB, Garcia AM, Coyne L, Ale C, Prezeworski A, Himle M, Early childhood OCD: preliminary findings from a family-based cognitive-behavioral approach. J Am Acad Child Adolesc Psychiatry 2008; 47: 593– 602. 18356758 PMC2820297
- [3]Piacentini J, Bergman RL, Keller M, McCracken J. Functional impairment in children and adolescents with obsessive-compulsive disorder. J Child Adolesc Psychopharmacol 2003; 13 (suppl 1): 61–9. 12880501
- [4]O'Kearney RT, Anstey K, von Sanden C, Hunt A. Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents. Cochrane Database Syst Rev 2006; 4: CD004856. PMC8855344 17054218
- [5]Dupont R, Rice D, Shiraki S, Rowland C. Economic costs of obsessive-compulsive disorder. Med Interface 1995; 8: 102–9. 10141765
- [7]Watson HJ, Rees CS. Meta-analysis of randomized, controlled treatment trials for pediatric obsessive compulsive disorder. J Child Psychol Psychiatry 2008; 49: 489–98. 18400058
- [9]Layard R. The case for psychological treatment centres. Br Med J 2006; 332: 1030–2. 16644834 PMC1450056
- [10]Mataix-Cols D, Marks I. Self-help with minimal therapist contact for obsessive-compulsive disorder: a review. Eur Psychiatry 2006; 21: 75– 80. 16360307
- [14]Taylor S, Thordarson DS, Spring T, Yeh AH, Corcoran KM, Eugster K, Telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Cogn Behav Ther 2003; 32: 13– 25. 16291531
- [16]Lovell K, Cox D, Haddock G, Jones C, Raines D, Garvey R, Telephone administered cognitive behaviour therapy for treatment of obsessive compulsive disorder: randomised controlled non-inferiority trial. BMJ 2006; 333: 883–7. 16935946 PMC1626332
- [19]Scahill L, Riddle MA, McSwiggin-Hardin M, Ort SI, King RA, Goodman WK, Children's yale-brown obsessive-compulsive scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 1997; 36: 844–52. 9183141
- [20]Turner C, Heyman I, Futh A, Lovell K. A pilot study of telephone cognitive-behavioural therapy for obsessive-compulsive disorder in young people. Behav Cogn Psychother 2009; 37: 469–74. 19545482
- [21]Mataix-Cols D, Turner C, Monzani B, Isomura K, Murphy C, Krebbs G, Cognitive-behavioural therapy with post-session d-cycloserine augmentation for paediatric obsessive-compulsive disorder: pilot randomised controlled trial. Br J Psychiatry 2014; 204: 77–8. 24262813
- [22]Brooks R. EuroQol: the current state of play. Health Policy 1996; 37: 53– 72. 10158943
- [23]Byford S. The validity and responsiveness of the EQ-5D measure of health-related quality of life in an adolescent population with persistent major depression. J Ment Health 2013; 22: 101–10. 23574502
- [24]Byford S, Barrett B, Roberts C, Clark A, Edwards V, Smethurst N, Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents. Br J Psychiatry 2007; 191: 436–40. 17978324
- [25]Byford S, Barrett B, Roberts C, Wilkinson P, Dubicka B, Kelvin RG, Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive-behavioural therapy in adolescents with major depression. Br J Psychiatry 2007; 191: 521–27. 18055956
- [27]British Medical Association and Royal Pharmaceutical Society. British National Formulary 62. BMJ Books and Pharmaceutical Press, 2011.
- [29]Drummond MF, Sculpher M, O'Brien B, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes (3rd edn) Oxford Medical Publications, 2005.
- [31]Dakin H, Wordsworth S. Cost-minimisation analysis versus cost-effectiveness analysis, revisited. Health Econ 2011; 22: 22– 34. 22109960
- [32]Briggs AH, O'Brien BJ. The death of cost-minimization analysis? Health Econ 2001; 10: 179–84. 11252048
- [33]Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Making 1998; 18: S68– 80. 9566468
- [34]Briggs AH, Fenn P. Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane. Health Econ 1998; 7: 723–40. 9890333
- [35]Fenwick E, Byford S. A guide to cost-effectiveness acceptability curves. Br J Psychiatry 2005; 187: 106–8. 16055820
- [36]Stant AD, Ten Vergert EM, den Boer PCAM WD. Cost-effectiveness of cognitive self-therapy in patients with depression and anxiety disorders. Acta Psychiatr Scand 2008; 117: 57– 66. 18005369
- [38]Lenhard F, Ssegonja R, Andersson E, Feldman I, Ruck C, Mataix-Cols D, Cost-effectiveness of therapist-guided internet-delivered cognitive behaviour therapy for paediatric obsessive-compulsive disorder: results from a randomised controlled trial. BMJ Open 2018; 7: e015246. PMC5729979 28515196
- [39]Lee W, Jones L, Goodman R, Heyman I. Broad outcome measures may underestimate effectiveness: an instrument comparison study. Child Adolesc Ment Health 2005; 10: 143–4. 32806851
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The Lancet Psychiatry Commission on youth mental health
McGorry, P. D., Mei, C., Dalal, N., Alvarez-Jimenez, M., Blakemore, S.-J., Browne, V., Dooley, B., Hickie, I. B., Jones, P. B., McDaid, D., et al. (2024) · The Lancet Psychiatry · doi:10.1016/s2215-0366(24)00163-9 · Cited by 663 · see citing works
Evidence of phone vs video-conferencing for mental health treatments: A review of the literature.
Chen, P. V., Helm, A., Caloudas, S. G., Ecker, A., Day, G., Hogan, J., & Lindsay, J. (2022) · Current Psychiatry Reports · doi:10.1007/s11920-022-01359-8 · Cited by 73 · see citing works
- Authors
- Tie, H., Krebs, G., Lang, K., Shearer, J., Turner, C., Mataix-Cols, D., Lovell, K., Heyman, I., & Byford, S.
- Affiliations
- King's College London (GB)
- The University of Queensland (AU)
- Greater Manchester Mental Health NHS Foundation Trust (GB)
- Great Ormond Street Hospital (GB)
- Corresponding author
- Byford, Sarah
- ORCID
- Venue
- BJPsych Open
- Publisher
- Royal College of Psychiatrists
- Published
- 2019-01
- Volume
- 5
- Issue
- 1
- Pages
- e7-e7
- ISSN
- 2056-4724 (ISSN-L)
- PMC
- PMC6343121
- OpenAlex
- W2908600084
- Cited by
- 17
- References
- 6
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2023: 2 · 2022: 4 · 2021: 3 · 2019: 1
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BJPsych Open (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Funders
- South London and Maudsley NHS Foundation Trust
- National Institute for Health and Care Research (PB-PG-0107-12333)
- King's College London
- Great Ormond Street Hospital for Children
- Karolinska Institutet
- Vetenskapsrådet
- Forskningsrådet om Hälsa, Arbetsliv och Välfärd
- Medical Research Council (MR/N001400/1)
- Research for Patient Benefit Programme
- National Institute of Mental Health
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- obsessive-compulsive disorder, adolescents, cost-effectiveness, quality-adjusted life years, non-inferiority, access to mental health care, telephone-delivered therapy
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