Abstract
Purpose :
Patients who receive anti-vascular endothelial growth factor (VEGF) treatment for retinal exudative diseases, often experience mental health problems. To support patients in dealing with these problems, a guided Internet-based self-help course, following the principles of cognitive behavioral therapy (called E-PsEYE), was developed. Our aim was to evaluate whether E-PsEYE was cost-effective in comparison with usual care from a societal perspective.
Methods :
A single blinded multicenter randomized controlled trial was performed in two parallel groups with a follow-up of 12 months. In total, 174 patients (58% male, mean age 70 year) who experienced mild to moderate symptoms of depression and/or anxiety and received anti-VEGF treatment participated in our study. Main outcome measures were depression (measured with the Patient Health Questionnaire-9), anxiety (measured with the Hospital Anxiety and Depression Scale – Anxiety), and quality-adjusted life years (QALYs, measured with the EuroQol-5 Dimensions and the Health Utilities Index-3). Costs were based on direct healthcare costs and indirect non-healthcare costs.
Results :
Based on intention to treat, significant intervention effects were found on depression (group difference −0.22, 95% confidence interval (CI) −0.43 to −0.01), but not on anxiety (−0.002, 95%CI −0.18 to 0.17). Non-significant societal cost savings were found (mean difference -1130 Euro; 95%CI -5101 to 2841, which is equivalent to -1387 USD; 95%CI -6263 to 3488), mainly due to less productivity losses in the intervention group. Drop-out (20% in total) was significantly higher in the intervention group. The cost-effectiveness acceptability curve showed that the probability of cost-effectiveness was 72% or more at a willingness-to-pay of €0 per QALY and did not increase at a higher ceiling ratio.
Conclusions :
Significant intervention effects on depression and small cost-savings were found, however, the difference with usual care was minimal. Therefore, we cannot state that E-PsEYE is dominant to usual care. Future studies should investigate how the cost-effectiveness of E-PsEYE can be improved.
This is a 2021 ARVO Annual Meeting abstract.