1. Cost-Effectiveness of Virtual Reality Cognitive Behavioral Therapy for Psychosis
- Author
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Filip Smit, Mark van der Gaag, Roos Pot-Kolder, Joran Lokkerbol, Chris N W Geraets, Helga K. Ising, Wim Veling, Alyssa Jongeneel, Epidemiology and Data Science, APH - Mental Health, Clinical Psychology, Perceptual and Cognitive Neuroscience (PCN), and Clinical Cognitive Neuropsychiatry Research Program (CCNP)
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Cost effectiveness ,Cost-Benefit Analysis ,medicine.medical_treatment ,Health Informatics ,lcsh:Computer applications to medicine. Medical informatics ,Virtual reality ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Humans ,Medicine ,psychosis ,Paranoia ,cost-effectiveness ,Average cost ,Aged ,Original Paper ,business.industry ,lcsh:Public aspects of medicine ,lcsh:RA1-1270 ,SDG 10 - Reduced Inequalities ,Middle Aged ,PERSECUTORY DELUSIONS ,Psychosis ,Cognitive behavioral therapy ,030227 psychiatry ,cognitive behavioral therapy ,Psychotic Disorders ,Strictly standardized mean difference ,Test score ,Economic evaluation ,Physical therapy ,lcsh:R858-859.7 ,virtual reality ,Female ,Cost-effectiveness ,medicine.symptom ,business ,030217 neurology & neurosurgery - 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 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
- Published
- 2020