Abstract
BackgroundGeneralized anxiety disorder (GAD) is a debilitating mental health illness that affects approximately 3.1% of U.S. adults and can be treated with cognitive behavioral therapy (CBT). With the emergence of digital health technologies, mobile CBT may be a cost-effective way to deliver care. We developed an analysis framework to quantify the cost-effectiveness of internet-based CBT for individuals with GAD. As a case study, we examined the potential value of a new mobile-delivered CBT program for GAD.MethodsWe developed a Markov model of GAD health states combined with a detailed economic analysis for a cohort of adults with GAD in the U.S. In our case study, we used pilot program efficacy data to evaluate a mobile CBT program as either prevention or treatment only and compared the strategies to traditional CBT and no CBT. Traditional CBT efficacy was estimated from clinical trial results. We calculated discounted incremental costs and quality-adjusted life-years (QALYs) over the cohort lifetime.Case study resultsIn the base case, for a cohort of 100,000 persons with GAD, we found that mobile CBT is cost-saving. It leads to a gain of 34,108 QALYs and 81,492 QALYs and a cost reduction of $2.23 billion and $4.54 billion when compared to traditional CBT and no CBT respectively. Results were insensitive to most model inputs and mobile CBT remained cost-saving in almost all scenarios.LimitationsThe case study was conducted for illustrative purposes and used mobile CBT efficacy data from a small pilot program; the analysis should be re-conducted once robust efficacy data is available. The model was limited in its ability to measure the effectiveness of CBT in combination with pharmacotherapy.ConclusionsMobile CBT may lead to improved health outcomes at lower costs than traditional CBT or no intervention and may be effective as either prevention or treatment.
Highlights
3.1% of the adult population in the United States (6.8 million adults) is affected by generalized anxiety disorder (GAD), a chronic and debilitating mental health illness that is characterized by low spontaneous remission rates and frequent relapse after remission [1,2,3]
Mobile cognitive behavioral therapy (CBT) may lead to improved health outcomes at lower costs than traditional CBT or no intervention and may be effective as either prevention or treatment
For a cohort of 100,000 persons with mild, moderate, or severe anxiety, we found that mobile CBT led to a gain of 34,108 qualityadjusted life-years (QALYs) when compared to traditional CBT and 81,492 QALYs when compared to the status quo (Table 2)
Summary
3.1% of the adult population in the United States (6.8 million adults) is affected by generalized anxiety disorder (GAD), a chronic and debilitating mental health illness that is characterized by low spontaneous remission rates and frequent relapse after remission [1,2,3]. Up to 60% of individuals with anxiety experience comorbid mental health illnesses and addictions, major depressive disorder (MDD) and substance abuse, as well as social anxiety disorder and post-traumatic stress disorder [4, 5, 7,8,9] This is associated with even worse disability, diminished functioning and impairment [4]. One analysis using data from the National Comorbidity Survey found that only 20% of individuals with GAD visited a healthcare specialist (e.g., psychologist, psychiatrist) in a given year [12] This treatment gap is partially due to structural and financial barriers that prevent access to healthcare specialists and traditional face-to-face CBT [13]. We examined the potential value of a new mobile-delivered CBT program for GAD
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