@Article{info:doi/10.2196/17098, author="Pot-Kolder, Roos and Veling, Wim and Geraets, Chris and Lokkerbol, Joran and Smit, Filip and Jongeneel, Alyssa and Ising, Helga and van der Gaag, Mark", title="Cost-Effectiveness of Virtual Reality Cognitive Behavioral Therapy for Psychosis: Health-Economic Evaluation Within a Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="May", day="5", volume="22", number="5", pages="e17098", keywords="psychosis; virtual reality; cognitive behavioral therapy; cost-effectiveness", abstract="Background: Evidence was found for the effectiveness of virtual reality-based cognitive behavioral therapy (VR-CBT) for treating paranoia in psychosis, but health-economic evaluations are lacking. Objective: This study aimed to determine the short-term cost-effectiveness of VR-CBT. Methods: The health-economic evaluation was embedded in a randomized controlled trial evaluating VR-CBT in 116 patients with a psychotic disorder suffering from paranoid ideation. The control group (n=58) received treatment as usual (TAU) for psychotic disorders in accordance with the clinical guidelines. The experimental group (n=58) received TAU complemented with add-on VR-CBT to reduce paranoid ideation and social avoidance. Data were collected at baseline and at 3 and 6 months postbaseline. Treatment response was defined as a pre-post improvement of symptoms of at least 20{\%} in social participation measures. Change in quality-adjusted life years (QALYs) was estimated by using Sanderson et al's conversion factor to map a change in the standardized mean difference of Green's Paranoid Thoughts Scale score on a corresponding change in utility. The incremental cost-effectiveness ratios were calculated using 5000 bootstraps of seemingly unrelated regression equations of costs and effects. The cost-effectiveness acceptability curves were graphed for the costs per treatment responder gained and per QALY gained. Results: The average mean incremental costs for a treatment responder on social participation ranged between {\texteuro}8079 and {\texteuro}19,525, with 90.74{\%}-99.74{\%} showing improvement. The average incremental cost per QALY was {\texteuro}48,868 over the 6 months of follow-up, with 99.98{\%} showing improved QALYs. Sensitivity analyses show costs to be lower when relevant baseline differences were included in the analysis. Average costs per treatment responder now ranged between {\texteuro}6800 and {\texteuro}16,597, while the average cost per QALY gained was {\texteuro}42,030. Conclusions: This study demonstrates that offering VR-CBT to patients with paranoid delusions is an economically viable approach toward improving patients' health in a cost-effective manner. Long-term effects need further research. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 12929657; http://www.isrctn.com/ISRCTN12929657 ", issn="1438-8871", doi="10.2196/17098", url="https://www.jmir.org/2020/5/e17098", url="https://doi.org/10.2196/17098", url="http://www.ncbi.nlm.nih.gov/pubmed/32369036" }