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Long-term clinical and cost-effectiveness of a therapist-supported online remote behavioural intervention for tics in children and adolescents : extended 12- and 18-month follow-up of a single-blind randomised controlled trial

Hollis, Chris ; Hall, Charlotte L. ; Khan, Kareem ; Jones, Rebecca ; Marston, Louise ; Le Novere, Marie ; Hunter, Rachael ; Andrén, Per LU ; Bennett, Sophie D. and Brown, Beverley J. , et al. (2023) In Journal of Child Psychology and Psychiatry and Allied Disciplines 64(6). p.941-951
Abstract

Background: Little is known about the long-term effectiveness of behavioural therapy for tics. We aimed to assess the long-term clinical and cost-effectiveness of online therapist-supported exposure and response prevention (ERP) therapy for tics 12 and 18 months after treatment initiation. Methods: ORBIT (online remote behavioural intervention for tics) was a two-arm (1:1 ratio), superiority, single-blind, multicentre randomised controlled trial comparing online ERP for tics with online psychoeducation. The trial was conducted across two Child and Adolescent Mental Health Services in England. Participants were recruited from these two sites, across other clinics in England, or by self-referral. This study was a naturalistic follow-up of... (More)

Background: Little is known about the long-term effectiveness of behavioural therapy for tics. We aimed to assess the long-term clinical and cost-effectiveness of online therapist-supported exposure and response prevention (ERP) therapy for tics 12 and 18 months after treatment initiation. Methods: ORBIT (online remote behavioural intervention for tics) was a two-arm (1:1 ratio), superiority, single-blind, multicentre randomised controlled trial comparing online ERP for tics with online psychoeducation. The trial was conducted across two Child and Adolescent Mental Health Services in England. Participants were recruited from these two sites, across other clinics in England, or by self-referral. This study was a naturalistic follow-up of participants at 12- and 18-month postrandomisation. Participants were permitted to use alternative treatments recommended by their clinician. The key outcome was the Yale Global Tic Severity Scale Total Tic Severity Score (YGTSS-TTSS). A full economic evaluation was conducted. Registrations are ISRCTN (ISRCTN70758207); ClinicalTrials.gov (NCT03483493). Results: Two hundred and twenty-four participants were enrolled: 112 to ERP and 112 to psychoeducation. The sample was predominately male (177; 79%) and of white ethnicity (195; 87%). The ERP intervention reduced baseline YGTSS-TTSS by 2.64 points (95% CI: −4.48 to −0.79) with an effect size of −0.36 (95% CI: −0.61 to −0.11) after 12 months and by 2.01 points (95% CI: −3.86 to −0.15) with an effect size of −0.27 (95% CI -0.52 to −0.02) after 18 months, compared with psychoeducation. Very few participants (<10%) started new tic treatment during follow-up. The cost difference in ERP compared with psychoeducation was £304.94 (−139.41 to 749.29). At 18 months, the cost per QALY gained was £16,708 for ERP compared with psychoeducation. Conclusions: Remotely delivered online ERP is a clinical and cost-effective intervention with durable benefits extending for up to 18 months. This represents an efficient public mental health approach to increase access to behavioural therapy and improve outcomes for tics.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
digital intervention, exposure and response prevention, long-term follow-up, randomised controlled trial, Tic disorders
in
Journal of Child Psychology and Psychiatry and Allied Disciplines
volume
64
issue
6
pages
941 - 951
publisher
Wiley-Blackwell
external identifiers
  • scopus:85146327788
  • pmid:36649686
ISSN
0021-9630
DOI
10.1111/jcpp.13756
language
English
LU publication?
no
additional info
Publisher Copyright: © 2023 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
id
1945b40d-ab92-4bd0-ba8d-e7b157bac84f
date added to LUP
2023-07-14 11:27:16
date last changed
2024-02-19 21:26:04
@article{1945b40d-ab92-4bd0-ba8d-e7b157bac84f,
  abstract     = {{<p>Background: Little is known about the long-term effectiveness of behavioural therapy for tics. We aimed to assess the long-term clinical and cost-effectiveness of online therapist-supported exposure and response prevention (ERP) therapy for tics 12 and 18 months after treatment initiation. Methods: ORBIT (online remote behavioural intervention for tics) was a two-arm (1:1 ratio), superiority, single-blind, multicentre randomised controlled trial comparing online ERP for tics with online psychoeducation. The trial was conducted across two Child and Adolescent Mental Health Services in England. Participants were recruited from these two sites, across other clinics in England, or by self-referral. This study was a naturalistic follow-up of participants at 12- and 18-month postrandomisation. Participants were permitted to use alternative treatments recommended by their clinician. The key outcome was the Yale Global Tic Severity Scale Total Tic Severity Score (YGTSS-TTSS). A full economic evaluation was conducted. Registrations are ISRCTN (ISRCTN70758207); ClinicalTrials.gov (NCT03483493). Results: Two hundred and twenty-four participants were enrolled: 112 to ERP and 112 to psychoeducation. The sample was predominately male (177; 79%) and of white ethnicity (195; 87%). The ERP intervention reduced baseline YGTSS-TTSS by 2.64 points (95% CI: −4.48 to −0.79) with an effect size of −0.36 (95% CI: −0.61 to −0.11) after 12 months and by 2.01 points (95% CI: −3.86 to −0.15) with an effect size of −0.27 (95% CI -0.52 to −0.02) after 18 months, compared with psychoeducation. Very few participants (&lt;10%) started new tic treatment during follow-up. The cost difference in ERP compared with psychoeducation was £304.94 (−139.41 to 749.29). At 18 months, the cost per QALY gained was £16,708 for ERP compared with psychoeducation. Conclusions: Remotely delivered online ERP is a clinical and cost-effective intervention with durable benefits extending for up to 18 months. This represents an efficient public mental health approach to increase access to behavioural therapy and improve outcomes for tics.</p>}},
  author       = {{Hollis, Chris and Hall, Charlotte L. and Khan, Kareem and Jones, Rebecca and Marston, Louise and Le Novere, Marie and Hunter, Rachael and Andrén, Per and Bennett, Sophie D. and Brown, Beverley J. and Chamberlain, Liam R. and Davies, E. Bethan and Evans, Amber and Kouzoupi, Natalia and McKenzie, Caitlin and Sanderson, Charlotte and Heyman, Isobel and Kilgariff, Joseph and Glazebrook, Cristine and Mataix-Cols, David and Serlachius, Eva and Murray, Elizabeth and Murphy, Tara}},
  issn         = {{0021-9630}},
  keywords     = {{digital intervention; exposure and response prevention; long-term follow-up; randomised controlled trial; Tic disorders}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{941--951}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Child Psychology and Psychiatry and Allied Disciplines}},
  title        = {{Long-term clinical and cost-effectiveness of a therapist-supported online remote behavioural intervention for tics in children and adolescents : extended 12- and 18-month follow-up of a single-blind randomised controlled trial}},
  url          = {{http://dx.doi.org/10.1111/jcpp.13756}},
  doi          = {{10.1111/jcpp.13756}},
  volume       = {{64}},
  year         = {{2023}},
}