Nina Egger1, Alexander Konnopka2, Manfred E Beutel3, Stephan Herpertz4, Wolfgang Hiller3, Juergen Hoyer5, Simone Salzer6, Ulrich Stangier7, Bernhard Strauss8, Ulrike Willutzki9, Joerg Wiltink3, Falk Leichsenring10, Eric Leibing6, Hans-Helmut König2. 1. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Germany. Electronic address: n.egger@uke.de. 2. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Germany. 3. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany. 4. Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Germany. 5. Clinical Psychology and Psychotherapy and Clinic for Psychotherapy and Psychosomatic Medicine, Technische Universitaet Dresden, Germany. 6. Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University Goettingen, Germany. 7. Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Germany. 8. Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena, Germany. 9. Clinical Psychology and Psychotherapy, University Witten/Herdecke, Germany. 10. Clinic of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Germany.
Abstract
BACKGROUND: To investigate the short-term cost-effectiveness of cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) compared to waiting list (WL). METHODS: The analysis was conducted alongside the SOPHO-NET multi-center efficacy trial. Patients were randomly assigned to CBT (n=209), PDT (n=207), or WL (n=79). Resource use was assessed prior and during treatment to determine direct and absenteeism costs. Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated based on remission and response rates. To visualize statistical uncertainty, cost-effectiveness acceptability curves (CEACs) were constructed based on adjusted net-benefit regression. Different values for the society׳s willingness to pay (WTP) were assumed. RESULTS: Both interventions were more efficacious than WL but were associated with increased direct costs besides intervention costs. Unadjusted ICERs per responder were €3615 for CBT and €4958 for PDT. Unadjusted ICERs per remitted patient were €5788 and €10,733. CEACs revealed a high degree of uncertainty: applying the 97.5% probability threshold, CBT proved cost-effective at a WTP ≥€16,100 per responder and ≥€26,605 per remitted patient. Regarding PDT cost-effectiveness only was certain for response at a WTP ≥€27,290. LIMITATIONS: The WL condition is assumed to represent untreated patients, although the expectation to start treatment in the near future probably affects symptom severity and health care utilization. CONCLUSIONS: At the end of treatment cost-effectiveness of CBT and PDT compared to WL is uncertain and depends on the societal WTP. The interventions may induce a more adequate utilization of other health care services - involving increased costs. Development of costs and effects in the long-run should be considered.
RCT Entities:
BACKGROUND: To investigate the short-term cost-effectiveness of cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) compared to waiting list (WL). METHODS: The analysis was conducted alongside the SOPHO-NET multi-center efficacy trial. Patients were randomly assigned to CBT (n=209), PDT (n=207), or WL (n=79). Resource use was assessed prior and during treatment to determine direct and absenteeism costs. Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated based on remission and response rates. To visualize statistical uncertainty, cost-effectiveness acceptability curves (CEACs) were constructed based on adjusted net-benefit regression. Different values for the society׳s willingness to pay (WTP) were assumed. RESULTS: Both interventions were more efficacious than WL but were associated with increased direct costs besides intervention costs. Unadjusted ICERs per responder were €3615 for CBT and €4958 for PDT. Unadjusted ICERs per remitted patient were €5788 and €10,733. CEACs revealed a high degree of uncertainty: applying the 97.5% probability threshold, CBT proved cost-effective at a WTP ≥€16,100 per responder and ≥€26,605 per remitted patient. Regarding PDT cost-effectiveness only was certain for response at a WTP ≥€27,290. LIMITATIONS: The WL condition is assumed to represent untreated patients, although the expectation to start treatment in the near future probably affects symptom severity and health care utilization. CONCLUSIONS: At the end of treatment cost-effectiveness of CBT and PDT compared to WL is uncertain and depends on the societal WTP. The interventions may induce a more adequate utilization of other health care services - involving increased costs. Development of costs and effects in the long-run should be considered.
Authors: Annemarie Abbing; Anne Ponstein; Susan van Hooren; Leo de Sonneville; Hanna Swaab; Erik Baars Journal: PLoS One Date: 2018-12-17 Impact factor: 3.240
Authors: J Salchow; J Mann; B Koch; J von Grundherr; W Jensen; S Elmers; L A Straub; E Vettorazzi; G Escherich; S Rutkowski; S Dwinger; C Bergelt; M Sokalska-Duhme; S Bielack; G Calaminus; K Baust; C F Classen; C Rössig; J Faber; H Faller; I Hilgendorf; J Gebauer; T Langer; M Metzler; S Schuster; C Niemeyer; A Puzik; D Reinhardt; U Dirksen; A Sander; M Köhler; J K Habermann; C Bokemeyer; A Stein Journal: BMC Cancer Date: 2020-01-06 Impact factor: 4.430