Cost-effectiveness of internet-delivered cognitive behaviour therapy for body dysmorphic disorder: results from a randomised controlled trial

ObjectivesTo evaluate the cost-effectiveness of internet-delivered cognitive behaviour therapy for body dysmorphic disorder (BDD-NET).DesignSecondary cost-effectiveness analysis from a randomised controlled trial on BDD-NET versus online supportive psychotherapy.SettingAcademic medical centre.ParticipantsSelf-referred adult patients with a primary diagnosis of body dysmorphic disorder and a score of 20 or higher on the modified Yale-Brown obsessive compulsive scale (n = 94). Patients receiving concurrent psychotropic drug treatment were included if the dose had been stable for at least two months and remained unchanged during the trial.InterventionsParticipants received either BDD-NET (n = 47) or online supportive psychotherapy (n = 47) for 12 weeks.Primary and secondary outcome measuresThe primary outcome measures were cost-effectiveness and cost-utility from a societal perspective, using remission status from a diagnostic interview and quality-adjusted life years from EQ-5D, respectively. Secondary outcome measures were cost-effectiveness and cost-utility from a health care perspective and the clinic’s perspective.ResultsCompared to supportive psychotherapy, BDD-NET produced one additional remission for an average societal cost of $4132. The cost-utility analysis showed that BDD-NET generated one additional QALY to an average cost of $14319 from a societal perspective.ConclusionsBDD-NET is a cost-effective treatment for body dysmorphic disorder, compared to online supportive psychotherapy. The efficacy and cost-effectiveness of BDD-NET should be directly compared to face-to-face cognitive behaviour therapy.Trial registrationNCT02010619Strengths and limitations of this studyThis is the first cost-effectiveness evaluation of a novel internet-delivered treatment designed to increase access to cognitive behaviour therapy for patients with body dysmorphic disorderCost estimations were self-rated and might not capture all costs associated with treatmentThe self-referred participants were likely motivated to undergo treatment.