Cost-effectiveness of internet-supported cognitive behavioral therapy for university students with anxiety symptoms: A Markov-model analysis

• Published in: PloS one Vol. 17; no. 5; p. e0268061
• Main Authors: You, Joyce H S, Luk, Scotty W C, Chow, Dilys Y W, Jiang, Xinchan, Mak, Arthur D P, Mak, Winnie W S
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05.05.2022; Public Library of Science (PLoS)
• Subjects: Age; Anxiety; Anxiety disorders; Behavior modification; Biology and Life Sciences; Care and treatment; Clinical trials; Cognitive ability; Cognitive therapy; College students; Complications and side effects; Computer and Information Sciences; Cost analysis; Cost benefit analysis; Diagnosis; Evaluation; Generalized anxiety disorder; Health surveys; Internet; Intervention; Markov chains; Medicine and Health Sciences; Mental disorders; Mental health; Modelling; Mortality; Patient outcomes; People and places; Psychological aspects; Remission (Medicine); Sensitivity analysis; Social Sciences; Statistical analysis; Students; Systematic review; University students; China; Hong Kong China; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0268061

High prevalence of anxiety symptoms has been reported globally in the university students. Cognitive behavioral therapy (CBT) is the recognized treatment for anxiety and is traditionally conducted face-to-face (f-CBT). The efficacy of internet-based CBT (i-CBT) for anxiety has been extensively studied, yet evidence on its cost-effectiveness is scarce. We aimed to evaluate the cost-effectiveness of guided low-intensity i-CBT for university students with mild anxiety symptoms from the societal perspective of Hong Kong. A 5-year Markov model was designed to compare outcomes of guided i-CBT and f-CBT in a hypothetical cohort of university students with mild anxiety symptoms. Model inputs of cost and healthcare resources associated with anxiety were retrospectively collected from a cohort of university students with anxiety symptoms. Clinical and utility model inputs were retrieved from published literature. Model outcome measures were anxiety-related total cost (including direct medical and indirect costs) and quality-adjusted life-year (QALY). Sensitivity analyses were performed to examine the robustness of base-case results. In base-case analysis, i-CBT gained higher QALYs (2.9956 versus 2.9917) at lower total cost (US$6,101 versus US$6,246) than f-CBT. In one-way sensitivity analysis, the QALY gained by i-CBT was sensitive to the relative patient acceptance and adherence to CBT. In probabilistic sensitivity analysis, i-CBT was cost-effective in 90.9% of the time at the willingness-to-pay threshold of 138,210 per QALY (3× GDP per capita in Hong Kong). The probability of i-CBT to be cost-effective was 99.9% at a willingness-to-pay threshold of zero. Guided i-CBT appears to be cost-saving and effective for management of university students with mild symptoms of anxiety from the societal perspective of Hong Kong. The cost-effectiveness of i-CBT is highly subject to the individual acceptance and adherence of CBT delivered by the internet platform.