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Abstract: Objective: To determine the cost‐effectiveness of individual face‐to‐face cognitive behavioral therapy (CBT) compared to therapist guided Internet‐based self‐help (GSH‐I) in overweight or obese adults with binge‐eating disorder (BED). Method: Analysis was conducted alongside the multicenter randomized controlled INTERBED trial. CBT (n = 76) consisted of up to 20 individual therapy sessions over 4 months. GSH‐I (n = 71) consisted of 11 modules combining behavioral interventions, exercises including a self‐monitoring food diary, psychoeducation, and 2 face‐to‐face coaching sessions over 4 months. Assessments at baseline, after 4 months (post‐treatment), as well as 6 and 18 months after the end of treatment included health care utilization and sick leave days to calculate direct and indirect costs. Binge‐free days (BFD) were calculated as effect measure based on the German version of the Eating Disorder Examination. The incremental cost‐effectiveness ratio (ICER) was determined, and net benefit regressions, adjusted for comorbidities and baseline differences, were used to derive cost‐effectiveness acceptability curves. Results: After controlling for baseline differences, CBT was associated with non‐significantly more costs (+€2,539) and BFDs (+40.1) compared with GSH‐I during the 22‐month observation period, resulting in an adjusted ICER of €63 per additional BFD. CBTs probability of being cost‐effective increased above 80% only if societal willingness to pay (WTP) was ≥€250 per BFD. Discussion: We did not find clear evidence for one of the treatments being more cost‐effective. CBT tends to be more effective but also more costly. If the societal WTP for an additional BFD is low, then our results suggest that GSH‐I should rather be adopted. [ABSTRACT FROM AUTHOR]

Background: To determine the cost-effectiveness of cognitive behavioral therapy (CBT) versus psychodynamic therapy (PDT) in the treatment of social anxiety disorder after a follow-up of 30 months from a societal perspective.Methods: This analysis was conducted alongside the multicenter SOPHO-NET trial; adults with a primary diagnosis of social anxiety disorder received CBT (n = 209) or PDT (n = 207). Data on health care utilization and productivity loss were collected at baseline, after 6 months (posttreatment), and three further follow-ups to calculate direct and indirect costs. Anxiety-free days (AFDs) calculated based on remission and response were used as measure of effect. The incremental cost-effectiveness ratio (ICER) was determined. Net benefit regressions, adjusted for comorbidities and baseline differences, were applied to derive cost-effectiveness acceptability curves.Results: In the descriptive analysis, the unadjusted ICER favored CBT over PDT and the adjusted analysis showed that CBT's cost-effectiveness relative to PDT depends on the willingness to pay (WTP) per AFD. As baseline costs differed substantially the unadjusted estimates might be deceptive. If additional WTPs for CBT of €0, €10, and €30 were assumed, the probability of CBT being cost-effective relative to PDT was 65, 83, and 96%. Direct costs increased compared to baseline across groups, whereas indirect costs did not change significantly. Results were sensitive to considered costs.Conclusions: If the society is willing to pay ≥€30 per additional AFD, CBT can be considered cost-effective, relative to PDT, with certainty. To further increase the cost-effectiveness more knowledge regarding predictors of treatment outcome seems essential. [ABSTRACT FROM AUTHOR]

Background To investigate the short-term cost-effectiveness of cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) compared to waiting list (WL). Methods The analysis was conducted alongside the SOPHO-NET multi-center efficacy trial. Patients were randomly assigned to CBT ( n =209), PDT ( n =207), or WL ( n =79). Resource use was assessed prior and during treatment to determine direct and absenteeism costs. Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated based on remission and response rates. To visualize statistical uncertainty, cost-effectiveness acceptability curves (CEACs) were constructed based on adjusted net-benefit regression. Different values for the society׳s willingness to pay (WTP) were assumed. Results Both interventions were more efficacious than WL but were associated with increased direct costs besides intervention costs. Unadjusted ICERs per responder were €3615 for CBT and €4958 for PDT. Unadjusted ICERs per remitted patient were €5788 and €10,733. CEACs revealed a high degree of uncertainty: applying the 97.5% probability threshold, CBT proved cost-effective at a WTP ≥€16,100 per responder and ≥€26,605 per remitted patient. Regarding PDT cost-effectiveness only was certain for response at a WTP ≥€27,290. Limitations The WL condition is assumed to represent untreated patients, although the expectation to start treatment in the near future probably affects symptom severity and health care utilization. Conclusions At the end of treatment cost-effectiveness of CBT and PDT compared to WL is uncertain and depends on the societal WTP. The interventions may induce a more adequate utilization of other health care services – involving increased costs. Development of costs and effects in the long-run should be considered. [ABSTRACT FROM AUTHOR]