title: Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: a randomized controlled trial.
abstract: A significant proportion of the general population suffers from anxiety disorders, often with comorbid psychiatric conditions. Internet-delivered cognitive behavior therapy (ICBT) has been found to be a potent treatment for patients with specific psychiatric conditions. The aim of this trial was to investigate the effectiveness and cost-effectiveness of ICBT when tailoring the treatment to address comorbidities and preferences for primary-care patients with a principal anxiety disorder. One hundred participants were recruited through their primary-care contact and randomized to either treatment or an active control group. The treatment consisted of 7-10 weekly individually assigned modules guided by online therapists. At post-treatment, 46% of the treatment group had achieved clinically significant improvement on the primary outcome measure (CORE-OM) and between-group effect sizes ranged from d = 0.20 to 0.86, with a mean effect of d = 0.59. At one-year follow-up, within-group effect sizes varied between d = 0.53 to 1.00. Cost analysis showed significant reduction of total costs for the ICBT group, the results were maintained at one-year follow-up and the incremental cost-effectiveness ratio favored ICBT compared to control group. Individually tailored ICBT is an effective and cost-effective treatment for primary-care patients with anxiety disorders with or without comorbidities.
  
  
  BACKGROUND
  Clinicaltrials.gov: NCT01390168.
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden. Electronic address: lise.bergman.nordgren@liu.se.
authors.forename: Lise Bergman
authors.initials: LB
authors.lastname: Nordgren
authors.affiliation: Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Hedman
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
authors.forename: Julie
authors.initials: J
authors.lastname: Etienne
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bodin
authors.affiliation: County Council of Östergötland, 581 91 Linköping, Sweden.
authors.forename: Asa
authors.initials: A
authors.lastname: Kadowaki
authors.affiliation: Department of Psychology, Umeå University, 901 87 Umeå, Sweden.
authors.forename: Stina
authors.initials: S
authors.lastname: Eriksson
authors.affiliation: Department of Psychology, Umeå University, 901 87 Umeå, Sweden.
authors.forename: Emelie
authors.initials: E
authors.lastname: Lindkvist
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden; Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, 171 77 Stockholm, Sweden.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Carlbring
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000191:economics / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care; D011788:Quality of Life; D013813:Therapy, Computer-Assisted / Q000191:economics*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anxiety; Cognitive behavior therapy; Comorbidity; Cost-effectiveness; Depression; Internet-delivered cognitive behavior therapy; Primary care