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Computer-Aided Self-Exposure Therapy for Phobia/Panic Disorder: A Pilot Economic Evaluation

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Phobia/panic disorder is common. It improves with exposure therapy, even when guided mainly by a computer self-help system such as FearFighter (FF), but such therapy must also demonstrate cost-effectiveness. This study compares the cost-effectiveness of FF with computed-aided relaxation and clinician-led exposure. Data were obtained on patients from a randomised controlled trial of FF. Economic analyses used pretreatment and 1-month follow-up self-ratings of the main problem and global phobia. Clinician costs were calculated using the number of therapist hours and the cost of FF. Incremental cost-effectiveness ratios were calculated and cost-effectiveness acceptability curves were produced. Data were available on 62 patients with main problem ratings and 60 with global phobia ratings. FF and clinician-led exposure were more effective than relaxation but more expensive. Compared with relaxation, producing an extra unit of improvement on the main problem scale cost £64 with FF and £100 with clinician-led exposure. FF appeared to be more cost-effective using the global phobia rating (£112 per extra unit of improvement vs. £128 for clinician-led exposure). The cost-effectiveness of FF could be enhanced if users had less highly trained supporters. FF would be less cost-effective if face-to-face therapy was delivered by less qualified professionals. Caution is urged regarding these indicative findings given that these were secondary analyses.

Keywords: cognitive behaviour therapy; economic evaluation; health care costs

Document Type: Research Article


Affiliations: 1: Centre for the Economics of Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London 2: Institute of Psychiatry, King's College London, London 3: Psychobiology of Anxiety and Obsessive-Compulsive Disorders Group, Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College London, London 4: West London Mental Health Trust, London 5: St. Patrick's Hospital, Dublin, Ireland

Publication date: June 1, 2009

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