Richard Morriss1, Georgios Xydopoulos2, Michael Craven3, Larry Price4, Richard Fordham2. 1. Institute of Mental Health and NIHR MindTech MTEC, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK. Electronic address: richard.morriss@nottingham.ac.uk. 2. University of East Anglia, Norwich Research Park, Norwich, UK. 3. NIHR MindTech MTEC, University of Nottingham, Nottingham, UK. 4. Measurement and Statistical Analysis, Texas State University, TX, USA.
Abstract
BACKGROUND:Cranial electrotherapy stimulation (CES) is a well-tolerated neuromodulation treatment with demonstrated trial efficacy in anxiety disorders. The aim of the current study was to demonstrate its clinical and cost effectiveness during and after CES in people with generalised anxiety disorder (GAD) who had not responded to low intensity psychological treatment in a routine health service. METHODS:Consecutive sample of eligible patients with GAD waiting forindividual cognitive behaviour therapy (CBT) selected from two publicly funded services in England. They received 60 min per day Alpha-Stim CES for 6-12 weeks. Primary outcome was remission on the GAD-7 scale at 12 and 24 weeks. Cost effectiveness was examined using a cost minimisation model of direct health costs. RESULTS: Of 161 patients recruited, 72 (44.7%) and 77 (47.8%) achieved remission on the GAD-7 at 12 and 24 weeks respectively with 122 (75.8%) receiving at least 6 weeks CES. Mean (sd) GAD-7 score at baseline significantly improved from 15.77 (3.21) to 8.92 (5.42) and 8.99 (6.18) at 12 and 24 weeks respectively (p < 0.001). 80 (49.7%) participants required further individual CBT. CES provided a saving of £540.88 per patient (95% CI -£327.12, £648.69). LIMITATIONS: Participants were not randomised and there was no control group. Only 48 (29.9%) participants completed every assessment. CONCLUSION: In patients with generalised anxiety disorder not responding to low intensity psychological treatment, 6-12 weeks dailyAlpha Stim CES may be effective after treatment and 3 months later, thereby reducing the need for individual CBT and saving health costs.
RCT Entities:
BACKGROUND: Cranial electrotherapy stimulation (CES) is a well-tolerated neuromodulation treatment with demonstrated trial efficacy in anxiety disorders. The aim of the current study was to demonstrate its clinical and cost effectiveness during and after CES in people with generalised anxiety disorder (GAD) who had not responded to low intensity psychological treatment in a routine health service. METHODS: Consecutive sample of eligible patients with GAD waiting for individual cognitive behaviour therapy (CBT) selected from two publicly funded services in England. They received 60 min per day Alpha-Stim CES for 6-12 weeks. Primary outcome was remission on the GAD-7 scale at 12 and 24 weeks. Cost effectiveness was examined using a cost minimisation model of direct health costs. RESULTS: Of 161 patients recruited, 72 (44.7%) and 77 (47.8%) achieved remission on the GAD-7 at 12 and 24 weeks respectively with 122 (75.8%) receiving at least 6 weeks CES. Mean (sd) GAD-7 score at baseline significantly improved from 15.77 (3.21) to 8.92 (5.42) and 8.99 (6.18) at 12 and 24 weeks respectively (p < 0.001). 80 (49.7%) participants required further individual CBT. CES provided a saving of £540.88 per patient (95% CI -£327.12, £648.69). LIMITATIONS: Participants were not randomised and there was no control group. Only 48 (29.9%) participants completed every assessment. CONCLUSION: In patients with generalised anxiety disorder not responding to low intensity psychological treatment, 6-12 weeks daily Alpha Stim CES may be effective after treatment and 3 months later, thereby reducing the need for individual CBT and saving health costs.
Authors: Shireen Patel; Clement Boutry; Priya Patel; Michael P Craven; Boliang Guo; Azhar Zafar; Joe Kai; David Smart; Debbie Butler; Fred Higton; Rebecca McNaughton; Paul M Briley; Chris Griffiths; Neil Nixon; Kapil Sayal; Richard Morriss Journal: Trials Date: 2022-04-04 Impact factor: 2.279
Authors: Simon Royal; Stuart Keeling; Nick Kelsall; Larry Price; Richard Fordham; Georgios Xydopoulos; Gerard R Dawson; Jonathan Kingslake; Richard Morriss Journal: BMC Prim Care Date: 2022-04-29