%0 Journal Article
%@ 1438-8871
%I JMIR Publications
%V 22
%N 5
%P e17098
%T Cost-Effectiveness of Virtual Reality Cognitive Behavioral Therapy for Psychosis: Health-Economic Evaluation Within a Randomized Controlled Trial
%A Pot-Kolder,Roos
%A Veling,Wim
%A Geraets,Chris
%A Lokkerbol,Joran
%A Smit,Filip
%A Jongeneel,Alyssa
%A Ising,Helga
%A van der Gaag,Mark
%+ Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 641034764, roos.potkolder@gmail.com
%K psychosis
%K virtual reality
%K cognitive behavioral therapy
%K cost-effectiveness
%D 2020
%7 5.5.2020
%9 Original Paper
%J J Med Internet Res
%G English
%X 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 €8079 and €19,525, with 90.74%-99.74% showing improvement. The average incremental cost per QALY was €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 €6800 and €16,597, while the average cost per QALY gained was €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 
%M 32369036
%R 10.2196/17098
%U https://www.jmir.org/2020/5/e17098
%U https://doi.org/10.2196/17098
%U http://www.ncbi.nlm.nih.gov/pubmed/32369036