Abstract
BackgroundA previous randomized controlled trial in older adults with anxiety symptoms found no differences between a brief blended Acceptance and Commitment Therapy (ACT) intervention and brief face-to-face Cognitive Behavior Therapy (CBT) regarding anxiety symptom severity at posttreatment and 12-month follow-up. A health-economic evaluation comparing these interventions has not yet been conducted.ObjectiveThis study examined the one-year cost-effectiveness and cost-utility of blended ACT compared to face-to-face CBT for older adults with anxiety symptoms.MethodsThe economic evaluation was embedded in a randomized controlled trial comparing blended ACT to CBT in 314 older adults with mild to moderately severe anxiety symptoms. Data were collected at baseline and 3, 6 and 12 months post baseline. For the cost-effectiveness analysis, treatment response was defined as a reliable improvement in anxiety symptom severity (measured with the Generalized Anxiety Disorder-7) between baseline and 12-month follow-up. To assess cost-utility, quality-adjusted life years (QALYs) were computed using EuroQol-5 Dimensions-5 Levels-5 utility scores. Analyses took the societal perspective, including both healthcare costs and productivity costs. Incremental cost-effectiveness ratios were calculated using 2500 bootstraps of seemingly unrelated regression equations of costs and effects. Sensitivity analyses were performed to assess the robustness of the findings.ResultsDifferences between the blended ACT group and CBT group in treatment response and QALYs were statistically insignificant and clinically irrelevant. The ACT intervention was associated with an average per-participant cost reduction of €466 ($593) compared to CBT, which resulted from lower productivity costs in the blended ACT group. From a healthcare perspective, the ACT intervention was associated with higher costs (by €71 ($90)) than CBT.ConclusionsThe results do not indicate that from a health-economic perspective blended ACT should be preferred over CBT in the treatment of older adults with anxiety symptoms. The findings support a model of shared decision making, where clinicians and patients collaboratively decide on the preferred intervention, based on ethical-medical, practical and personal considerations.Trial registrationNetherlands Trial Register: TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131.
Highlights
Anxiety symptoms are the most prevalent mental health problem in older adults (55 years and over) and have an adverse impact on subjective well-being, quality of life, physical health and everyday functioning [1,2,3,4,5]
The ACT intervention was associated with an average per-participant cost reduction of €466 ($593) compared to Cognitive Behavior Therapy (CBT), which resulted from lower productivity costs in the blended ACT group
Studies have indicated that online and blended CBT interventions are effective at reducing anxiety symptom severity in older adults, which is promising as scalable internet-based interventions are likely to become crucial in providing this large patient population with adequate psychological treatment [13,14,15,16]
Summary
A previous randomized controlled trial in older adults with anxiety symptoms found no differences between a brief blended Acceptance and Commitment Therapy (ACT) intervention and brief face-to-face Cognitive Behavior Therapy (CBT) regarding anxiety symptom severity at posttreatment and 12-month follow-up. A health-economic evaluation comparing these interventions has not yet been conducted. Data Availability Statement: Data cannot be shared publicly because they contain sensitive participant information. Data are available from the Leiden Repository Committee (contact via research_psych@fsw.leidenuniv.nl) for researchers who meet the criteria for access to confidential data.
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