Cost-utility analysis of telephone-based cognitive behavior therapy in chronic obstructive pulmonary disease (COPD) patients with anxiety and depression comorbidities: an application for willingness to accept concept

ABSTRACT

Background: This study evaluated the cost-utility of telephone-based cognitive behavioral therapy (TB-CBT) (experimental arm) in comparison with a placebo-befriending (control arm) program in COPD participants with mild to severe depression and/or anxiety.

Methods: The decision rule was based on willingness-to-pay if there is an increased unit of effectiveness (a quality-adjusted life year [QALY] gain) and an increase in cost, and willingness-to-accept (WTA) if there is a reduced unit of effectiveness (a QALY loss) and decrease in cost (a cost-saving).

Results: TB-CBT group was associated with a reduction in the incremental cost of AUS−$407.3 (p < 0.001, SE:34.1) plus a negative, nonsignificant incremental QALY gain of −0.008 (SE:0.011) per patient compared to control group. The point estimate of the mean incremental cost-utility ratio was AUS$50,284.0 cost saving per QALY sacrificed (the high value associated with small QALY value in the denominator). Ninety-five percent CI was AUS$13,426 cost sacrificed to AUS$32,018 cost gain (lower values associated with larger QALY values in the denominator). If the societal’s minimum (flooring threshold) WTA is AUS$64,000 per QALY forgone, the probability of TB-CBT being cost-effective was 42%

Conclusions: This study showed that TB-CBT can be recommended as a cost-saving and preventive approach over usual care plus befriending program.

KEYWORDS:

• Economic evaluation
• willingness to accept (WTA)
• utility
• AQoL
• chronic obstructive pulmonary disease (COPD)
• cognitive behavior therapy (CBT)

Acknowledgments

The authors thank Mr. Chris Chiu, MPhil, for his contribution in the methodology of this economic evaluation. The authors thank Philip Clarke, PhD, Professor, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne and Allison Yates, a health economics PhD candidate at University of Melbourne for reviewing the paper and providing input.

Declaration of interest

F Moayeri received a PhD scholarship fund from University of Melbourne Faculty of Medicine, Dentistry and Health Sciences. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All the authors interpreted data, read, and approved the final manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approvals for the study were obtained from: Melbourne Health (2011.140), Alfred Health (HREC 304/11), Austin Health (H2012/04665), Barwon Health (HREC/12/VICBH/29), Eastern Health (E32/1213), and Bendigo Health (HREC/13/BHCG/9).

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

Financial support for this study was provided entirely by Beyondblue (Project 304/11) and was undertaken with assistance from the National Ageing Research Institute (NARI). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The correspondence author received PhD scholarship fund from University of Melbourne Faculty of Medicine, Dentistry and Health Sciences. Clinical trials identifier: ACTRN12612000254897. Available at www.anzctr.org.au/ACTRN12612000254897.aspx.