Stepped-care, internet-delivered CBT model cost-effective for youth with OCD

A stepped-care cognitive behavioral therapy model was cost-effective for children and adolescents with obsessive-compulsive disorder, according to an economic evaluation of a randomized noninferiority trial published in JAMA Network Open.

“To increase the availability of high-quality CBT, we developed a therapist- and parent-guided internet-delivered CBT program for children and adolescents with OCD,” Kristina Aspvall, PhD, of the Centre for Psychiatry Research in the department of clinical neuroscience at Karolinska Institutet in Sweden, and colleagues wrote. “Families work their way through a series of interactive online CBT modules and receive asynchronous support from a clinician via a dedicated online platform. This low-intensity intervention has demonstrated efficacy and cost-effectiveness in three open studies and one randomized waitlist clinical superiority trial.”

Aspvall and colleagues aimed to assess the cost-effectiveness of guided CBT delivered via the internet and implemented within a stepped-care model compared with CBT delivered in person for young people with OCD. The randomized noninferiority trial they analyzed occurred at two specialist OCD clinics in Sweden and enrolled 152 children and adolescents aged 8 to 17 years (62% girls; mean age, 13.4 years) who had OCD, 72% of whom were through clinician referrals. Through random assignment, the participants received either guided internet-delivered CBT or in-person CBT across 16 weeks. Nonresponders in both groups had the option of additional in-person CBT therapy sessions at the 3-month follow-up. Response rates served as the primary outcome, and remission rates and quality-adjusted life-years as additional outcomes. The researchers analyzed cost data collected before and after treatment, as well as at 3-month and 6-month follow-up. They compared the between-group differences in incremental costs and health outcomes and presented them from health care professional, health care sector and societal perspectives.

A total of 50 of 74 participants (68%) in the stepped-care group and 52 of 77 participants (68%) in the in-person CBT group responded to treatment (OR = 1; 95% CI, 0.51-1.98). According to health economic analyses, those in the stepped-care group used fewer therapist resources compared with the in-person CBT group, which resulted in a mean cost savings of $2,104 per participants for the full study period of 10 months. This corresponded to a relative savings of 39%. Viewed from wider health care sector and societal perspectives, the cost savings remained largely comparable, according to the researchers

“This study suggests that a stepped-care model in which young people with OCD are first offered a low-cost digital CBT intervention followed by traditional in-person therapy for nonresponders is as effective as, and more cost-effective than, the traditional in-office treatment format,” Aspvall and colleagues wrote. “The findings provide important implications for clinical practice and health policy.”