Estimating the Economic Value of Automated Virtual Reality Cognitive Therapy for Treating Agoraphobic Avoidance in Patients With Psychosis: Findings From the gameChange Randomized Controlled Clinical Trial

TY - JOUR

T1 - Estimating the Economic Value of Automated Virtual Reality Cognitive Therapy for Treating Agoraphobic Avoidance in Patients With Psychosis

T2 - Findings From the gameChange Randomized Controlled Clinical Trial

AU - Altunkaya, James

AU - Craven, Michael

AU - Lambe, Sinéad

AU - Beckley, Ariane

AU - Rosebrock, Laina

AU - Dudley, Robert

AU - Chapman, Kate

AU - Morrison, Anthony

AU - O'Regan, Eileen

AU - Grabey, Jenna

AU - Bergin, Aislinn

AU - Kabir, Thomas

AU - Waite, Felicity

AU - Freeman, Daniel

AU - Leal, José

N1 - Funding Information: This research was funded by the National Health Service National Institute for Health and Care Research (NIHR) Invention for Innovation program (II-C7-0117-20001). This work was also supported by NIHR Oxford Health Biomedical Research Centre funding (BRC-1215-20005). The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR, or the Department of Health and Social Care in England. AB and MC are supported by the NIHR Nottingham Biomedical Research Centre and NIHR MindTech MedTech Co-operative. FW is funded by a Wellcome Trust Clinical Doctoral Fellowship (102176/B/13/Z). DF is an NIHR Senior Investigator. Publisher Copyright: © James Altunkaya, Michael Craven, Sinéad Lambe, Ariane Beckley, Laina Rosebrock, Robert Dudley, Kate Chapman, Anthony Morrison, Eileen O'Regan, Jenna Grabey, Aislinn Bergin, Thomas Kabir, Felicity Waite, Daniel Freeman, José Leal.

PY - 2022/11/18

Y1 - 2022/11/18

N2 - Background: An automated virtual reality cognitive therapy (gameChange) has demonstrated its effectiveness to treat agoraphobia in patients with psychosis, especially for high or severe anxious avoidance. Its economic value to the health care system is not yet established. Objective: In this study, we aimed to estimate the potential economic value of gameChange for the UK National Health Service (NHS) and establish the maximum cost-effective price per patient. Methods: Using data from a randomized controlled trial with 346 patients with psychosis (ISRCTN17308399), we estimated differences in health-related quality of life, health and social care costs, and wider societal costs for patients receiving virtual reality therapy in addition to treatment as usual compared with treatment as usual alone. The maximum cost-effective prices of gameChange were calculated based on UK cost-effectiveness thresholds. The sensitivity of the results to analytical assumptions was tested. Results: Patients allocated to gameChange reported higher quality-adjusted life years (0.008 QALYs, 95% CI -0.010 to 0.026) and lower NHS and social care costs (-£105, 95% CI -£1135 to £924) compared with treatment as usual (£1=US $1.28); however, these differences were not statistically significant. gameChange was estimated to be worth up to £341 per patient from an NHS and social care (NHS and personal social services) perspective or £1967 per patient from a wider societal perspective. In patients with high or severe anxious avoidance, maximum cost-effective prices rose to £877 and £3073 per patient from an NHS and personal social services perspective and societal perspective, respectively. Conclusions: gameChange is a promising, cost-effective intervention for the UK NHS and is particularly valuable for patients with high or severe anxious avoidance. This presents an opportunity to expand cost-effective psychological treatment coverage for a population with significant health needs.

AB - Background: An automated virtual reality cognitive therapy (gameChange) has demonstrated its effectiveness to treat agoraphobia in patients with psychosis, especially for high or severe anxious avoidance. Its economic value to the health care system is not yet established. Objective: In this study, we aimed to estimate the potential economic value of gameChange for the UK National Health Service (NHS) and establish the maximum cost-effective price per patient. Methods: Using data from a randomized controlled trial with 346 patients with psychosis (ISRCTN17308399), we estimated differences in health-related quality of life, health and social care costs, and wider societal costs for patients receiving virtual reality therapy in addition to treatment as usual compared with treatment as usual alone. The maximum cost-effective prices of gameChange were calculated based on UK cost-effectiveness thresholds. The sensitivity of the results to analytical assumptions was tested. Results: Patients allocated to gameChange reported higher quality-adjusted life years (0.008 QALYs, 95% CI -0.010 to 0.026) and lower NHS and social care costs (-£105, 95% CI -£1135 to £924) compared with treatment as usual (£1=US $1.28); however, these differences were not statistically significant. gameChange was estimated to be worth up to £341 per patient from an NHS and social care (NHS and personal social services) perspective or £1967 per patient from a wider societal perspective. In patients with high or severe anxious avoidance, maximum cost-effective prices rose to £877 and £3073 per patient from an NHS and personal social services perspective and societal perspective, respectively. Conclusions: gameChange is a promising, cost-effective intervention for the UK NHS and is particularly valuable for patients with high or severe anxious avoidance. This presents an opportunity to expand cost-effective psychological treatment coverage for a population with significant health needs.

KW - cost-effectiveness

KW - economic evaluation

KW - gameChange

KW - maximum price

KW - National Health Service

KW - NHS

KW - virtual reality

UR - http://www.scopus.com/inward/record.url?scp=85142402098&partnerID=8YFLogxK

U2 - 10.2196/39248

DO - 10.2196/39248

M3 - Article

C2 - 36399379

AN - SCOPUS:85142402098

SN - 1438-8871

VL - 24

JO - JOURNAL OF MEDICAL INTERNET RESEARCH

JF - JOURNAL OF MEDICAL INTERNET RESEARCH

IS - 11

M1 - e39248

ER -