S.M.A.A. Evers

Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial

BACKGROUND Computerised cognitive-behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression. AIMS To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care. METHOD Three hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period. RESULTS No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses. CONCLUSIONS Online, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depression.

Economic evaluation of online computerised cognitive–behavioural therapy without support for depression in primary care: randomised trial

BACKGROUND Evidence about the cost-effectiveness and cost utility of computerised cognitive-behavioural therapy (CCBT) is still limited. Recently, we compared the clinical effectiveness of unsupported, online CCBT with treatment as usual (TAU) and a combination of CCBT and TAU (CCBT plus TAU) for depression. The study is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236). AIMS To assess the cost-effectiveness of CCBT compared with TAU and CCBT plus TAU. METHOD Costs, depression severity and quality of life were measured for 12 months. Cost-effectiveness and cost-utility analyses were performed from a societal perspective. Uncertainty was dealt with by bootstrap replications and sensitivity analyses. RESULTS Costs were lowest for the CCBT group. There are no significant group differences in effectiveness or quality of life. Cost-utility and cost-effectiveness analyses tend to be in favour of CCBT. CONCLUSIONS On balance, CCBT constitutes the most efficient treatment strategy, although all treatments showed low adherence rates and modest improvements in depression and quality of life.

Improving adherence and effectiveness of computerised cognitive behavioural therapy without support for depression: A qualitative study on patient experiences

BACKGROUND Several studies have evaluated the efficacy and effectiveness of computerized cognitive behavioural therapy (CCBT) for depression, but research on the patient perspective is limited. AIMS To gain knowledge on patient experiences with the online self-help CCBT program Colour Your Life (CYL) for depression, and find explanations for the low treatment adherence and effectiveness. METHOD Qualitative data were collected through semi-structured interviews with 18 patients. Interviewees were selected from a CCBT trial. An inductive, content analysis of the interviews was performed. RESULTS The main theme throughout the interviews concerns barriers and motivators experienced with CCBT. The most important barriers included experiences of a lack of identification with and applicability of CCBT-CYL, lack of support to adhere with the program or to gain deeper understanding, and inadequate computer/Internet skills, equipment, or location. Confusion between CCBT and Internet questionnaires resulted in no CCBT uptake of some study participants. Motivators included experiencing self-identification and improvement through CCBT-CYL, participating in a scientific study, and the freedom and anonymity associated with online computer self-help. The addition of support to CCBT was suggested as an improvement towards adherence and the course content. CONCLUSION The CCBT program CYL in its current form does not work for a large group of people with depressive symptoms. More tailoring, the provision of support (professional or lay) and good computer conditions could improve CCBT.

One-year follow-up results of unsupported online computerized cognitive behavioural therapy for depression in primary care: A randomized trial

OBJECTIVE To report the one-year follow-up results of computerized cognitive behavioural therapy (CCBT), offered online without professional support, for depression compared with usual GP care and a combination of both treatments. To explore potential relapse prevention effects of CCBT. METHODS 303 depressed patients were randomly allocated to (a) unsupported online CCBT (b) treatment as usual (TAU), or (c) CCBT and TAU combined. We had a 12-month follow-up period. Primary outcome measure was the Beck Depression Inventory II. Self-reported health care use was also measured. KEY FINDINGS At 12 months, no statistically significant differences between the three interventions are found in the intention-to-treat population for depressive severity, reliable improvement, remission, and relapse. In the first quarter, differences in health care consumption between the three interventions are significant (i.e. less GP contacts, less antidepressant medication, and less specialist mental health care in the CCBT group), but these differences disappear over time. CONCLUSIONS Unsupported online CCBT is not superior to TAU by a GP for depression. With equal effects, CCBT alone leads to less health care consumption than TAU and CCBT&TAU. Overall effects are modest in all interventions, which can be explained by the finding that the use of health care services decreases despite the lack of substantial improvements.

Compensation Mechanisms for Lost Productivity: A Comparison between Four European Countries

OBJECTIVE Productivity costs are usually estimated by multiplying the wage with the period absent. This can lead to an overestimation if compensation mechanisms occur. Until now only Dutch data are available on the influence of compensation mechanisms on lost productivity, but between-country differences in frequency and type of compensation mechanisms can be expected. The objective of this study was to understand whether compensation mechanisms for days absent from paid work differ in type and frequency across countries and to explore whether this would result in between-country differences in relevant lost productivity. METHODS Data from a cross-sectional survey among respondents with rheumatic disorders from four countries were the basis for this study. Analyses focused on respondents with paid employment who reported absence in the last 3 months. The different compensation mechanisms are described and the resulting lost productivity in terms of days absent was calculated with and without taking compensation mechanisms into account. Logistic regression analyses were performed to examine which variables influence compensation mechanisms leading to relevant lost productivity. RESULTS The results indicate that compensation mechanisms occur and are relevant in all four countries. Between-country differences in the type and frequency of compensation mechanisms and relevant lost productivity were observed. The logistic regression analyses indicate that, correcting for other variables, this is also the case for the use of compensation mechanisms leading to relevant lost productivity. CONCLUSIONS Between-country differences in compensation mechanisms in case of absenteeism exist and could vary to such an extent that foreign relevant lost productivity data should be used with caution.

QUANTITY AND QUALITY OF EXTERNAL EVENT VALIDATION PROCEDURES PERFORMED IN PUBLISHED HEALTH ECONOMIC MODELS IN OBESITY : OUTCOMES OF A SYSTEMATIC REVIEW

 We have found that only a limited number of published decision models for full HEAs in obesity have applied an external event validation.  In addition, those who conducted external validation suffers from major limitations including the data source selection process, as only in one case, obesity cohorts were used as basis for the validation procedure.  Thus in conclusion published obesity models lack information on the predictive quality of the applied event simulation approaches.

Risk of Bias in Trial-Based Economic Evaluations.

Objective: The objective of this article is to give first an overview of the risks of bias in trial-based economic evaluations, and second to identify how key sources for bias can be revealed and overcome (bias-reducing strategies) in future trial-based economic evaluation in the field of health psychology. Design: Narrative reviews discussing a particular source of bias in trial-based economic evaluation and bias-reducing strategies. Results: The different forms of bias are presented, and assigned to a particular trial phase. A distinction is made between pre-trial biases, biases during the trial and biases that are relevant after the actual trial. All potential forms of bias are discussed in detail and strategies are shown to detect and overcome these biases. Conclusion: In order to avoid bias in trial-based economic evaluations, one has to be aware of all of the possible forms of bias and all stakeholders have to examine trial-based economic evaluations in a rigorous and stringent manner. This article can be helpful in this examination as it gives an overview of the possible biases which researchers should take into account.

PMC56 THE TRANSFERABILITY OF ECONOMIC EVALUATIONS. VALIDATING THE MODEL OF WELTE

recommended in the FDA draft guidance for industry. A systematic review of PROs assures that the best available instrument is used to measure the preferred endpoint. As systematic reviews are scientific exercises, they require the same rigour as other aspects of research, yet current methods used to conduct systematic reviews remain variable, meaning that the quality and comparability of such reviews is not assured. Our aim was to explore the comprehensiveness, understandability, and adaptability of two widely used methodologies in conducting and modifying a standard search.METHODS:We compared the most common systematic review method (syntax search) and the Cochrane-collaboration recommended “Population-Intervention-Comparator-Outcome” (PICO) strategy. SCOPUS was searched using terms devised to answer the research question “which PROs have been used to date in islet cell transplantation?” The output resulting from each strategy was independently evaluated by two researchers and the methods critiqued. RESULTS: Both methods returned 6486 abstracts for review. Researchers were asked to identify ways in which to combine search terms to present a more manageable number for abstract screening. Both researchers agreed that PICO allowed for greater adaptability and targeted reviewing without compromising quality. Combining a priori search terms systematically according to [P and (I or C) and O], resulted in 359 abstracts. CONCLUSIONS: The quality of a review depends on the extent to which scientific reviewmethods are used to minimise the risk of error and bias, but also the extent to which the search strategy is replicable and flexible. The PICO method is comparable to the standard syntax search, but offers the added benefits of being easy to implement, and sufficiently versatile to allow further targeting according to subtle changes in the research question as desired.

PMC12 MODELLING THE VALUE FOR MONEY OF CLINICAL PRACTICE CHANGE: A STOCHASTIC APPLICATION IN DIABETES CARE

effectiveness analysis will increasingly play an informative role in policy analysis of public health interventions even though it is not clear what discount rate is appropriate in each case. However, especially for programmes characterized by long-term diminished risk of disease, death or sequel avoided, possibility of disease eradication, and substantial intergenerational impact, there are no convincing arguments favouring the use of subjective time preferences when setting official discount rates for application in social project evaluation.