Abstract

BackgroundEvidence 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.ObjectiveThis study aimed to determine the short-term cost-effectiveness of VR-CBT.MethodsThe 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.ResultsThe 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.ConclusionsThis 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 RegistrationInternational Standard Randomised Controlled Trial Number (ISRCTN) 12929657; http://www.isrctn.com/ISRCTN12929657

Highlights

  • Psychotic disorders impose a large disease burden—morbidity plus mortality—on the population, and in its wake, substantial economic costs occur for society and health care systems

  • This study demonstrates that offering virtual reality-based cognitive behavioral therapy (VR-cognitive behavioral therapy (CBT)) to patients with paranoid delusions is an economically viable approach toward improving patients’ health in a cost-effective manner

  • The health-economic evaluation was embedded in a randomized controlled trial evaluating virtual reality (VR)-CBT in 116 patients with a psychotic disorder suffering from paranoid ideation [10]

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Summary

Introduction

Psychotic disorders impose a large disease burden—morbidity plus mortality—on the population, and in its wake, substantial economic costs occur for society and health care systems. The main drivers of societal costs of schizophrenia are health care costs and productivity losses, but patients and their families incur substantial costs [1]. Low participation rates of individuals with psychosis in the labor market are an important cause of productivity losses, while the main contributor to health care costs are in-patient psychiatric admissions [2]. Virtual reality-based cognitive behavioral therapy (VR-CBT) was found to be an effective treatment for paranoid ideation in individuals with a psychotic disorder [9,10]. This study was designed to evaluate whether adding VR-CBT to treatment as usual (TAU) would be effective in treating paranoid ideation in a cost-effective way with respect to improving social participation. 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

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