JMIR Publications

ABSTRACT

Background:

There is evidence for the effectiveness of virtual reality based cognitive behavioural therapy (VR-CBT) for treating paranoia in psychosis, but health-economic evaluations are lacking.

Objective:

This study aimed to determine a short-term cost-effectiveness of VR-CBT from a societal perspective.

Methods:

The health-economic evaluation was embedded in a randomized controlled trial on 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. Nine months of data were collected at baseline, three and six months post baseline. Treatment response was defined as a pre-post symptoms improvement of at least 20% in social participation measures. Change in quality adjusted life years (QALY) was estimated by using Sanderson’s conversion factor to map a change in Green’s Paranoid Thoughts Scale (GPTS) standardized mean difference on a corresponding change in utility. The incremental cost-effectiveness ratios (ICERs) were calculated using 5,000 bootstraps of seemingly unrelated regression equations of costs and effects. The cost-effectiveness acceptability curves were graphed for the costs per treatment responder and per QALY gained.

Results:

The average mean incremental costs for a treatment responder on social participation ranged between €8,079-€19,525, with 90.74 to 99.74% showing improvement. The average incremental cost per QALY was €48,868 over the six 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 €6,800 and €16,597, average cost per QALY gained was €42,030.

Conclusions:

The study demonstrates that offering VR-CBT to patients with paranoid delusions is an economically viable approach towards improving the patients’ health in a cost-effective manner. Long-term effects need further research. Clinical Trial: ISRCTN number 12929657