Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 26, 2025
Date Accepted: Jun 6, 2025
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From controlled trials to real-world experience: Costs and outcomes of a therapist-guided internet-delivered cognitive behavioral therapy program
ABSTRACT
Background:
Therapist-guided internet-delivered cognitive behavioral therapy (iCBT) has demonstrated efficacy and potential cost-effectiveness for treating depression, anxiety, and panic disorders in randomized controlled trials. However, evidence of its outcomes and costs in routine care settings on a national level remains limited.
Objective:
This study aimed to assess the outcomes of therapist-guided iCBT for depression, social anxiety and panic disorder at post-treatment and six-months follow-up, while also exploring how the program’s costs and effects varied by hospital.
Methods:
This single-arm observational study analyzed patient-reported data collected from 2021 to 2024 in four hospitals in Norway. A broad range of outcomes was assessed, including the Patient Health Questionnaire (PHQ-9), Social Phobia Inventory (SPIN), Panic Disorder Severity Scale (PDSS), EuroQol 5D-5L (EQ-5D), Work and Social Adjustment Scale (WSAS), and sick leave days. Mixed effects models were used to estimate changes in outcomes over time and between hospitals. The economic evaluation was performed in a hospital perspective and extended to a societal perspective by including sick leave.
Results:
Data from 565 participants showed substantial improvements across all outcomes at post-treatment and six-months follow-up. Patients reported improved well-being and increased functioning. Reduction in sickness absence was also observed. Overall, 35.1% of participants responded positively to treatment (Depression: 31.4%: Social Anxiety: 26.6%; Panic Disorder: 51.4%), whereas 23.7% achieved remission from symptoms (Depression: 12.2%: Social Anxiety: 35.6%; Panic Disorder: 34.3%). Mean (SD) total program costs per patient were €981.2 (SD 430.17), which varied by location (€606.2 to €2050.3), mostly due to differences in patient volume. Outcomes were consistent across hospitals.
Conclusions:
This study confirms the potential of therapist-guided iCBT to relieve symptom severity and improve well-being across different health service providers when implemented as part of routine specialist healthcare. The observed variance in costs per patient between hospitals underscores the importance of patient volume to optimize efficient use of resources. Clinical Trial: NCT05868135
Citation
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