Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 21, 2022
Date Accepted: Apr 20, 2023
Efficacy and Cost-effectiveness Analysis of Internet-based Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: A Randomized Controlled Trial
ABSTRACT
Background:
Obsessive-Compulsive Disorder (OCD) is a common and chronic mental illness with a high rate of disability. Internet-based Cognitive Behavioral Therapy (ICBT) makes online treatment available to patients, and has been shown to be effective. However, three arm trials on ICBT, conventional CBT, and medication only were still lacking.
Objective:
The study was a randomized, controlled, assessor-blinded trial of three groups in the obsessive-compulsive disorder: Internet-based Cognitive Behavioral Therapy (ICBT) combined with medication, Cognitive Behavioral Group Therapy (CBGT) combined with medication, and conventional medical treatment (TAU). The study aimed to investigate the efficacy and cost-effectiveness of ICBT related to CBGT and TAU for adults with OCD in China.
Methods:
99 OCD patients were selected and randomly assigned to the ICBT group, CBGT group, and TAU group for treatment of 6 weeks in the study. The primary outcomes were the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and self-rating Florida Obsessive-Compulsive Inventory (FOCI), compared at baseline, during treatment(3-week), and after treatment(6-week) to analyze efficacy. The secondary outcome was the EQ-VAS scores of the EuroQol five-dimensional questionnaire (EQ-5D). The cost questionnaires were recorded to analyze the cost-effectiveness.
Results:
Repeated measures ANOVA was used for data analysis, and the final effective data was 93 (ICBT=32, CBGT=28, TAU=33). There was no statistically significant difference in scores between the YBOCS (F=.73, P=.49) and FOCI (F=.23, P=.80) at the baseline of the three groups. After 6-week treatment, the YBOCS scores of the three groups significantly decreased (P<.001), and there was no significant differences among groups. The FOCI score of the ICBT group (P =.001) and CBGT group (P =.035) were significantly lower than that of the TAU group after treatment. The total cost of the CBGT group (6678.45 (95%CI 4460.88-8896.01) RMB ($1010.36 (95%CI 678.87-1345.84) USD)) was significantly higher than that of the ICBT group (3308.81 (95%CI 2476.89-4140.73) RMB ($500.58 (95%CI 374.72-626.43) USD)) (P<.001) and the TAU group (2259.61 (95%CI 2074.16-2445.05) RMB ($341.85 (95%CI 313.79-369.90) USD)) (P<.001) after treatment. The ICBT group spent 303.19 ($45.97 USD) RMB less than the CBGT group and 11.57 ($1.75 USD) RMB less than the TAU group for each unit YBOCS reduction score.
Conclusions:
Therapist-guided ICBT for OCD was as effective as conventional CBT and medication therapy, and was more cost-effective. It is expected to become one way to improve the treatment effect of patients with OCD. Clinical Trial: Clinical Trial Registry ChiCTR1900023840; http://www.chictr.org.cn/index.aspx
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