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

Altunkaya, James; Craven, Michael; Lambe, Sinéad; Beckley, Ariane; Rosebrock, Laina; Dudley, Robert; Chapman, Kate; Morrison, Anthony; O'Regan, Eileen; Grabey, Jenna; Bergin, Aislinn; Kabir, Thomas; Waite, Felicity; Freeman, Daniel; Leal, José

Abstract

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. TRIAL REGISTRATION: ISRCTN Registry ISRCTN17308399; https://www.isrctn.com/ISRCTN17308399. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2019-031606.

Citation

Altunkaya, J., Craven, M., Lambe, S., Beckley, A., Rosebrock, L., Dudley, R., Chapman, K., Morrison, A., O'Regan, E., Grabey, J., Bergin, A., Kabir, T., Waite, F., Freeman, D., & Leal, J. (2022). 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. Journal of Medical Internet Research, 24(11), Article e39248. https://doi.org/10.2196/39248

• Journal Article Type: Article
• Acceptance Date: Oct 17, 2022
• Online Publication Date: Nov 18, 2022
• Publication Date: Nov 18, 2022
• Deposit Date: Nov 19, 2022
• Publicly Available Date: Nov 24, 2022
• Electronic ISSN: 1438-8871
• Publisher: JMIR Publications
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Issue: 11
• Article Number: e39248
• DOI: https://doi.org/10.2196/39248
• Keywords: Health Informatics
• Public URL: https://nottingham-repository.worktribe.com/output/13755075
• Publisher URL: https://www.jmir.org/2022/11/e39248