Economic evaluation of videoconference group Acceptance and Commitment Therapy and Behavioral Activation Therapy for Depression versus usual care among adults with chronic low back pain plus comorbid depressive symptoms.
Por:
Sanabria JP, Francesco D'Amico, Cardeñosa E, Ferrer-Forés M, Edo S, Borràs X, McCracken LM, Feliu A, Sanz A and Luciano JV
Publicada:
1 jul 2024
Ahead of Print:
17 ene 2024
Resumen:
Chronic pain and depression are frequently comorbid conditions associated with significant healthcare and social costs. This study examined the cost-utility and cost-effectiveness of videoconference-based group forms of Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD), as a complement to treatment-as-usual (TAU), for patients with chronic low back pain (CLBP) plus depressive symptoms, compared to TAU alone. A trial-based economic evaluation (n = 234) was conducted from a governmental and healthcare perspective with a time horizon of 12 months. Primary outcomes were the Brief Pain Inventory-Interference Scale (BPI-IS) and Quality Adjusted Life Year (QALY). Compared to TAU, ACT achieved a significant reduction in total costs (d = 0.47), and BATD achieved significant reductions in indirect (d = 0.61) and total costs (d = 0.63). Significant improvements in BPI-IS (d = 0.73 and d = 0.66, respectively) and QALY scores (d = 0.46 and d = 0.28, respectively) were found in ACT and BATD compared to TAU. No significant differences in costs and outcomes were found between ACT and BATD. In the intention-to-treat analyses, from the governmental and healthcare perspective, no significant differences in cost reduction and incremental effects were identified in the comparison between ACT, BATD, and TAU. However, in the complete case analysis, significant incremental effects of ACT (?BPI-IS = -1.57 and -1.39, respectively) and BATD (?BPI-IS = -1.08 and -1.04, respectively) compared with TAU were observed. In the per-protocol analysis, only the significant incremental effects of ACT (?BPI-IS = -1.68 and -1.43, respectively) compared to TAU were detected. In conclusion, ACT and BATD might be efficient options in the management of CLBP plus comorbid depression symptoms as compared to usual care. However, no clear difference was found in the comparison between the two active therapies regarding cost-effectiveness or cost-utility. PERSPECTIVE: The economic evaluation of psychological therapies for the management of complex conditions is crucial as can be used in decision-making and resource allocation. This study provides evidence that videoconference group-based forms of ACT and BATD are more effective and involve a greater reduction in costs than usual care in the management of CLBP plus comorbid depressive symptoms. Both psychological therapies seem to offer good value for money to the Spanish national health service and the government.
Filiaciones:
Sanabria JP:
Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
Francesco D'Amico:
Care Policy and Evaluation Centre, London School of Economics and Political Science, United Kingdom
Cardeñosa E:
Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
Basic Health Area (ABS) Maria Bernades, Direcció d'Atenció Primària Metropolitana Sud, Institut Català de la Salut, Viladecans, Spain
Ferrer-Forés M:
Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
Institut de Recerca Hospital del Mar, Barcelona, Spain
Edo S:
Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
Borràs X:
Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
McCracken LM:
Psychology Department, Uppsala University, Uppsala, Sweden
Feliu A:
Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
Sanz A:
Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
Luciano JV:
Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain. Electronic address: juanvicente.luciano@uab.cat
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