Efficacy and Cost-Effectiveness Analysis of Internet-Based Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: 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, 3-arm trials on ICBT, face-to-face cognitive behavioral group therapy (CBGT), and only medication are still lacking. Objective This study is a randomized, controlled, assessor-blinded trial of 3 groups for OCD: ICBT combined with medication, CBGT combined with medication, and conventional medical treatment (ie, treatment as usual [TAU]). The study aims to investigate the efficacy and cost-effectiveness of ICBT related to CBGT and TAU for adults with OCD in China. Methods In total, 99 patients with OCD were selected and randomly assigned to the ICBT, CBGT, and TAU groups for treatment for 6 weeks. The primary outcomes were the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the self-rating Florida Obsessive-Compulsive Inventory (FOCI), compared at baseline, during treatment (3 weeks), and after treatment (6 weeks), to analyze efficacy. The secondary outcome was the EuroQol Visual Analogue Scale (EQ-VAS) scores of the EuroQol 5D Questionnaire (EQ-5D). The cost questionnaires were recorded to analyze cost-effectiveness. Results Repeated-measures ANOVA was used for data analysis, and the final effective sample size was 93 (ICBT: n=32, 34.4%; CBGT: n=28, 30.1%; TAU: n=33, 35.5%). After 6-week treatment, the YBOCS scores of the 3 groups significantly decreased (P<.001), and there were no significant differences among groups. The FOCI score of the ICBT (P=.001) and CBGT (P=.035) groups was significantly lower than that of the TAU group after treatment. The total cost of the CBGT group (renminbi [RMB] 6678.45, 95% CI 4460.88-8896.01 [US $1010.36, 95% CI 678.87-1345.84]) was significantly higher than that of the ICBT group (RMB 3308.81, 95% CI 2476.89-4140.73[US $500.58, 95% CI 374.72-626.43], P<.001) and the TAU group (RMB 2259.61, 95% CI 2074.16-2445.05 [US $341.85, 95% CI 313.79-369.90], P<.001) after treatment. The ICBT group spent RMB 303.19 (US $45.97) less than the CBGT group and RMB 11.57 (US $1.75) less than the TAU group for each unit reduction in the YBOCS score. Conclusions Therapist-guided ICBT combined with medication is as effective as face-to-face CBGT combined with medication for OCD. ICBT combined with medication is more cost-effective than CBGT combined with medication and conventional medical treatment. It is expected to become an efficacious and economic alternative for adults with OCD when face-to-face CBGT is not available. Trial Registration Chinese Clinical Trial Registry ChiCTR1900023840; https://www.chictr.org.cn/showproj.html?proj=39294

Long-term effectiveness and cost-effectiveness of guided internet-based cognitive behavioral therapy for obsessive-compulsive disorder: 24-month follow-up

“…We observed a significant reduction in OCD severity compared with baseline, not only immediately post-intervention but also at the 6-, 12-, and 24-month follow-up periods. Most previous guided ICBT studies have focused on short-term effectiveness ( Andersson et al, 2012 ; Mahoney et al, 2014 ; Wootton et al, 2013 ; Wootton et al, 2019 ; Wu et al, 2023 ), while our findings suggest long-term effectiveness, which has never been reported. The proportion of remitters increased from 44 % post-treatment to 80 % at the 12-month follow-up and 76 % at the 24-month follow-up, suggesting that guided ICBT has a delayed treatment effect on OCD.…”

“…To the best of our knowledge, this study is the first to provide evidence based on long-term observational data in guided ICBT for OCD in Japan. The previous studies on guided ICBT in adults with OCD has suggested short-term cost-effectiveness based on follow-up data from treatment initiation to 6 months ( Andersson et al, 2015 ; Matsumoto et al, 2022 ; Wu et al, 2023 ). To our knowledge, the present study provides the first evidence of sustained cost-effectiveness for 24 months based on actual measured QALYs, thus expanding insights into the cost-effectiveness of guided ICBT in patients with OCD.…”

“…On the other hand, a cost-benefit analysis from the perspective of social costs has not been performed in this study due to the unavailability of data on direct and indirect costs. In Australia, Sweden, and China, the analysis from a societal perspective suggested that guided ICBT options could deliver substantial benefits to society ( Andersson et al, 2015 ; Osborne et al, 2019 ; Wu et al, 2023 ). Since economic evaluations could significantly influence the structure of the healthcare system within regions or countries, future studies of guided ICBT for OCD in Japan should conduct cost-benefit analysis from the perspective of social costs.…”

“…Its effectiveness has been well-demonstrated when supported by therapist guidance and promising results have been reported in numerous Western regions and cultural contexts, particularly in Nordic countries ( Andersson et al, 2012 ; Mahoney et al, 2014 ; Wootton et al, 2019 ; Lundström et al, 2022 ). Additionally, the short-term effectiveness of ICBT has been demonstrated in randomized controlled trials (RCTs) within Asian cultural contexts such as Japan and China ( Matsumoto et al, 2022 ; Wu et al, 2023 ). Recently, an ICBT program for OCD and Body Dysmorphic Disorder was introduced in the Swedish public health system.…”

“…Previous studies have demonstrated the effectiveness of guided ICBT for the treatment of OCD. However, the evidence supporting these findings is primarily based on short-term OCD outcomes assessed immediately following treatment or at 3 to 6-month follow-up points ( Wootton et al, 2013 ; Herbst et al, 2014 ; Mahoney et al, 2014 ; Kyrios et al, 2018 ; Matsumoto et al, 2022 ; Wu et al, 2023 ). In other words, current research on guided ICBT has primarily focused on its short-term effectiveness; only two studies have reported a 12-month long-term follow-up ( Wootton et al, 2015 ; Lundström et al, 2022 ), while only one reported a 24-month follow-up ( Andersson et al, 2014 ).…”