Cost-effectiveness of virtual reality cognitive behavioral therapy for psychosis : Health-economic evaluation within a randomized controlled trial
(2020) In Journal of Medical Internet Research 22(5).- Abstract
Background: Evidence was found for the effectiveness of virtual reality-based cognitive behavioral therapy (VR-CBT) for treating paranoia in psychosis, but health-economic evaluations are lacking. Objective: This study aimed to determine the short-term cost-effectiveness of VR-CBT. Methods: The health-economic evaluation was embedded in a randomized controlled trial evaluating VR-CBT in 116 patients with a psychotic disorder suffering from paranoid ideation. The control group (n=58) received treatment as usual (TAU) for psychotic disorders in accordance with the clinical guidelines. The experimental group (n=58) received TAU complemented with add-on VR-CBT to reduce paranoid ideation and social avoidance. Data were collected at baseline... (More)
Background: Evidence was found for the effectiveness of virtual reality-based cognitive behavioral therapy (VR-CBT) for treating paranoia in psychosis, but health-economic evaluations are lacking. Objective: This study aimed to determine the short-term cost-effectiveness of VR-CBT. Methods: The health-economic evaluation was embedded in a randomized controlled trial evaluating VR-CBT in 116 patients with a psychotic disorder suffering from paranoid ideation. The control group (n=58) received treatment as usual (TAU) for psychotic disorders in accordance with the clinical guidelines. The experimental group (n=58) received TAU complemented with add-on VR-CBT to reduce paranoid ideation and social avoidance. Data were collected at baseline and at 3 and 6 months postbaseline. Treatment response was defined as a pre-post improvement of symptoms of at least 20% in social participation measures. Change in quality-adjusted life years (QALYs) was estimated by using Sanderson et al's conversion factor to map a change in the standardized mean difference of Green's Paranoid Thoughts Scale score on a corresponding change in utility. The incremental cost-effectiveness ratios were calculated using 5000 bootstraps of seemingly unrelated regression equations of costs and effects. The cost-effectiveness acceptability curves were graphed for the costs per treatment responder gained and per QALY gained. Results: The average mean incremental costs for a treatment responder on social participation ranged between €8079 and €19,525, with 90.74%-99.74% showing improvement. The average incremental cost per QALY was €48,868 over the 6 months of follow-up, with 99.98% showing improved QALYs. Sensitivity analyses show costs to be lower when relevant baseline differences were included in the analysis. Average costs per treatment responder now ranged between €6800 and €16,597, while the average cost per QALY gained was €42,030. Conclusions: This study demonstrates that offering VR-CBT to patients with paranoid delusions is an economically viable approach toward improving patients' health in a cost-effective manner. Long-term effects need further research. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 12929657; http://www.isrctn.com/ISRCTN12929657.
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- author
- Pot-Kolder, Roos ; Veling, Wim ; Geraets, Chris LU ; Lokkerbol, Joran ; Smit, Filip ; Jongeneel, Alyssa ; Ising, Helga and Van Der Gaag, Mark
- publishing date
- 2020-05
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cognitive behavioral therapy, Cost-effectiveness, Psychosis, Virtual reality
- in
- Journal of Medical Internet Research
- volume
- 22
- issue
- 5
- article number
- e17098
- publisher
- JMIR Publications Inc.
- external identifiers
-
- scopus:85084270953
- pmid:32369036
- ISSN
- 1438-8871
- DOI
- 10.2196/17098
- language
- English
- LU publication?
- no
- additional info
- Publisher Copyright: © 2020 Journal of Medical Internet Research. All rights reserved.
- id
- 1ca39f77-6b2a-4c98-bba0-d1105ce9c140
- date added to LUP
- 2024-10-21 10:40:39
- date last changed
- 2025-07-01 08:50:24
@article{1ca39f77-6b2a-4c98-bba0-d1105ce9c140,
abstract = {{<p>Background: Evidence was found for the effectiveness of virtual reality-based cognitive behavioral therapy (VR-CBT) for treating paranoia in psychosis, but health-economic evaluations are lacking. Objective: This study aimed to determine the short-term cost-effectiveness of VR-CBT. Methods: The health-economic evaluation was embedded in a randomized controlled trial evaluating VR-CBT in 116 patients with a psychotic disorder suffering from paranoid ideation. The control group (n=58) received treatment as usual (TAU) for psychotic disorders in accordance with the clinical guidelines. The experimental group (n=58) received TAU complemented with add-on VR-CBT to reduce paranoid ideation and social avoidance. Data were collected at baseline and at 3 and 6 months postbaseline. Treatment response was defined as a pre-post improvement of symptoms of at least 20% in social participation measures. Change in quality-adjusted life years (QALYs) was estimated by using Sanderson et al's conversion factor to map a change in the standardized mean difference of Green's Paranoid Thoughts Scale score on a corresponding change in utility. The incremental cost-effectiveness ratios were calculated using 5000 bootstraps of seemingly unrelated regression equations of costs and effects. The cost-effectiveness acceptability curves were graphed for the costs per treatment responder gained and per QALY gained. Results: The average mean incremental costs for a treatment responder on social participation ranged between €8079 and €19,525, with 90.74%-99.74% showing improvement. The average incremental cost per QALY was €48,868 over the 6 months of follow-up, with 99.98% showing improved QALYs. Sensitivity analyses show costs to be lower when relevant baseline differences were included in the analysis. Average costs per treatment responder now ranged between €6800 and €16,597, while the average cost per QALY gained was €42,030. Conclusions: This study demonstrates that offering VR-CBT to patients with paranoid delusions is an economically viable approach toward improving patients' health in a cost-effective manner. Long-term effects need further research. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 12929657; http://www.isrctn.com/ISRCTN12929657.</p>}},
author = {{Pot-Kolder, Roos and Veling, Wim and Geraets, Chris and Lokkerbol, Joran and Smit, Filip and Jongeneel, Alyssa and Ising, Helga and Van Der Gaag, Mark}},
issn = {{1438-8871}},
keywords = {{Cognitive behavioral therapy; Cost-effectiveness; Psychosis; Virtual reality}},
language = {{eng}},
number = {{5}},
publisher = {{JMIR Publications Inc.}},
series = {{Journal of Medical Internet Research}},
title = {{Cost-effectiveness of virtual reality cognitive behavioral therapy for psychosis : Health-economic evaluation within a randomized controlled trial}},
url = {{http://dx.doi.org/10.2196/17098}},
doi = {{10.2196/17098}},
volume = {{22}},
year = {{2020}},
}