Mobile and traditional cognitive behavioral therapy programs for generalized anxiety disorder: A cost-effectiveness analysis

<div><p>Background</p><p>Generalized anxiety disorder (GAD) is a debilitating mental health illness that affects approximately 3.1% of U.S. adults and can be treated with cognitive behavioral therapy (CBT). With the emergence of digital health technologies, mobile CBT may be a cost-effective way to deliver care. We developed an analysis framework to quantify the cost-effectiveness of internet-based CBT for individuals with GAD. As a case study, we examined the potential value of a new mobile-delivered CBT program for GAD.</p><p>Methods</p><p>We developed a Markov model of GAD health states combined with a detailed economic analysis for a cohort of adults with GAD in the U.S. In our case study, we used pilot program efficacy data to evaluate a mobile CBT program as either prevention or treatment only and compared the strategies to traditional CBT and no CBT. Traditional CBT efficacy was estimated from clinical trial results. We calculated discounted incremental costs and quality-adjusted life-years (QALYs) over the cohort lifetime.</p><p>Case study results</p><p>In the base case, for a cohort of 100,000 persons with GAD, we found that mobile CBT is cost-saving. It leads to a gain of 34,108 QALYs and 81,492 QALYs and a cost reduction of $2.23 billion and$4.54 billion when compared to traditional CBT and no CBT respectively. Results were insensitive to most model inputs and mobile CBT remained cost-saving in almost all scenarios.</p><p>Limitations</p><p>The case study was conducted for illustrative purposes and used mobile CBT efficacy data from a small pilot program; the analysis should be re-conducted once robust efficacy data is available. The model was limited in its ability to measure the effectiveness of CBT in combination with pharmacotherapy.</p><p>Conclusions</p><p>Mobile CBT may lead to improved health outcomes at lower costs than traditional CBT or no intervention and may be effective as either prevention or treatment.</p></div

Total costs for CBT interventions and status quo.

<p>Total costs for CBT interventions and status quo.</p

Total reduction in costs and improvement in QALYs.

<p>Total reduction in costs and improvement in QALYs.</p

Summary of key model parameters.

<p>Summary of key model parameters.</p

Markov model structure.

<p>This model includes 7 health states where persons can move between states at 3-month intervals. In the base case, all persons begin in the “mild anxiety,” “moderate anxiety” or “severe anxiety” states. In the prevention only case, all persons begin in the “mild anxiety” state. In the treatment only case, all persons begin in the “moderate anxiety” or “severe anxiety” state. Every cycle, persons could transition to a healthier GAD state, progress to a more severe GAD state (e.g., relapse), remain in the same state, or die.</p

Trabecular Microarchitecture in the Distal Femur of Adult WT and FAK−/− Mice.

<p>Mean ± SD; <i>n</i>, sample number; BV/TV, bone volume; Tb.N, trabecular number; Tb.Th, trabecular thickness; Tb.Sp, trabecular spacing; Conn.D, connectivity density; SMI, structure model index; ^a<i>p</i><0.05 versus gender-matched WT group.</p

Expression of phosphorylated Pyk2 in FAK+/+ and FAK−/− osteoblasts.

<p>Expression and localization of phosphorylated Pyk2 at Tyr-402 (red) in FAK+/+ (A) and FAK−/− (B) osteoblasts. DAPI nuclei stain in blue. Magnification = 60×. Scale bar represents 25 µm.</p

Structural Properties of the Femur in WT and FAK−/− Adult Mice.

<p>Mean ± SD; <i>n</i>, sample number; I_MAX, maximum second moment of area; I_MIN, minimum second moment of area; Ct.Ar, cortical area; Ct.Th, cortical thickness; ^a<i>p</i><0.05 versus gender-matched WT group.</p

Focal adhesion formation and actin cytoskeleton in wild-type and FAK−/− osteoblasts.

<p>(A–C) FAK+/+ osteoblasts form focal adhesions (red) as shown by vinculin staining and display prominent actin fiber formation (green) as shown by phalloidin staining. (D–F) FAK−/− osteoblasts also exhibit actin fiber and focal adhesion formation. Panels C and F show merged images. DAPI nuclei stain in blue. Magnification = 60×. Scale bar represents 25 µm.</p

Relative bone formation parameters in WT and FAK−/− male and female mice.

<p>Conditional deletion of FAK did not affect relative mineralizing surface (rMS/BS), relative mineral apposition rate (rMAR) or relative bone formation rate (rBFR/BS), which is a product of rMS/BS and rMAR. Data are presented as box and whisker plots where the median, Q2, Q3 and whiskers, representing the 5% and 95% confidence intervals, are depicted.</p