Cost effectiveness of computerised cognitive behavioural therapy (cCBT)

Cost effectiveness of computerised cognitive behavioural therapy (cCBT)

Subject: Economics

Major in: Health Economics and Economic Evaluation
Assessment

Cost effectiveness of computerised cognitive behavioural therapy (cCBT)

Background: CBT is often argued to be an effective intervention. However there is a shortage of trained therapists and cCBT could offer a potential alternative.

For the purposes of this assessment we have created a hypothetical data set from a centre which has monitored certain elements of resource use and outcomes for two groups of adults who were enrolled in a randomised controlled trial (see accompanying excel spreadsheet). All trial participants had depression/anxiety. Those assigned to group 1 received cCBT (cCBT guides patients through a comprehensive psychological therapy programme using a computer system). Guidance / technical help for cCBT was provided by the local GP practice nurse. Those assigned to group 2 were offered group based CBT (up to 6 sessions with up to 12 group members) by a trained therapist. Both groups were followed up for 2 years post-randomisation. A data dictionary is attached to help you understand the spreadsheet.

In the light of this new data we would like you to discuss whether cCBT represents a cost-effective use of health care resources and justify your answer. The commentary (of no more than 3,500 words) should explain the analysis undertaken and its relevance to practice and policy.

A successful essay will be clearly written and will:
– define the question addressed in the study,
– be written in accordance with the checklist outlined by Drummond et al. 2005,
– review existing work, showing ability to find such studies,
– justify the form of evaluation chosen,
– outline and justify any assumptions that are taken within the analysis,
– report findings in line with guidelines for economic evaluation,
– reflect on the validity of the results for the purpose intended and their generalisability,
– discuss the implications of the findings

The report should be written in the style of a paper to e.g. be submitted to the International Journal of Health Technology Assessment.

Data dictionary:

Patient ID Unique patient identifier

Group 1= cCBT; 0 = control group (group CBT)

Gender 1=male; 2=female

Age Age (years)

CBT_g Number of group based CBT sessions in a 1 year period

CBT_n Number of individual CBT sessions in a 1 year period

nurse_t Number of telephone consultations with a GP practice in a 1 year period

nurse_n Number of practice nurse visits in a 1 year period

GP_n Number of GP visits in a 1 year period

Psychiatrist_n Number of psychiatrist visits in a 1 year period

EQ_mobility_T0 Baseline score on the mobility dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_selfcare_T0 Baseline score on the self-care dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_usualactivities_T0 Baseline score on the usual activities dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_paindiscom_T0 Baseline score on the pain/discomfort dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_anxdep_T0 Baseline score on the anxiety/depression dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

CBT_g2 Number of group based CBT sessions in year 2

CBT_n2 Number of individual CBT sessions in year 2

nurse_t2 Number of telephone consultations with a GP practice in year 2

nurse_n2 Number of practice nurse visits in year 2

GP_n2 Number of GP visits in year 2

Psychiatrist_n2 Number of psychiatrist visits in year 2

EQ_mobility_T1 1 year follow up score on the mobility dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_selfcare_T1 1 year follow up score on the on the self-care dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_usualactivities_T1 1 year follow up score on the usual activities dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_paindiscom_T1 1 year follow up score on the pain/discomfort dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_anxdep_T1 2 year follow up score on the anxiety/depression dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_mobility_T2 2 year follow up score on the mobility dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_selfcare_T2 2 year follow up score on the on the self-care dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_usualactivities_T2 2 year follow up score on the usual activities dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_paindiscom_T2 2 year follow up score on the pain/discomfort dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

EQ_anxdep_T2 2 year follow up score on the anxiety/depression dimension of the EQ-5D
(1=no problems; 2=some problems; 3=extreme problems)

Please see the attached requirements, Excel and materials for clear understanding.

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