title: Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety: a randomized controlled trial.
abstract: There is preliminary support for internet-delivered cognitive behaviour therapy (iCBT) as a way of improving access to treatment among older adults with anxiety. The aim of this randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of an iCBT program for adults over 60 years of age with anxiety. Successful applicants were randomly allocated to either the treatment group (n=35) or the waitlist control group (n=37). The online treatment course was delivered over 8 weeks and provided with brief weekly contact with a clinical psychologist via telephone or secure email. Eighty-four percent of participants completed the iCBT course within the 8 weeks and 90% provided data at posttreatment. Significantly lower scores on measures of anxiety (Cohen's d=1.43; 95% CI: 0.89 - 1.93) and depression (Cohen's d=1.79; 95% CI: 1.21 - 2.32) were found among the treatment group compared to the control group at posttreatment. These lower scores were maintained at 3-month and 12-month follow-up and the treatment group rated the iCBT treatment as acceptable. The treatment group had slightly higher costs ($92.2; 95% CI: $38.7 to $149.2) and Quality-Adjusted Life-Years (QALYs=0.010; 95% CI: 0.003 to 0.018) than the control group at posttreatment and the intervention was found to have a greater than 95% probability of being cost-effective. The results support iCBT as an efficacious and cost-effective treatment option for older adults with symptoms of anxiety.
  
  
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  Australian and New Zealand Clinical Trials Registry: ACTRN12611000929909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000929909.
authors: Macquarie University. Electronic address: blake.dear@mq.edu.au.
authors: Blake F
authors: BF
authors: Dear
authors: Macquarie University.
authors: Judy B
authors: JB
authors: Zou
authors: University of York.
authors: Shehzad
authors: S
authors: Ali
authors: Macquarie University.
authors: Carolyn N
authors: CN
authors: Lorian
authors: Macquarie University.
authors: Luke
authors: L
authors: Johnston
authors: Macquarie University.
authors: Joanne
authors: J
authors: Sheehan
authors: Macquarie University.
authors: Lauren G
authors: LG
authors: Staples
authors: Macquarie University.
authors: Milena
authors: M
authors: Gandy
authors: Macquarie University.
authors: Vincent J
authors: VJ
authors: Fogliati
authors: Federation University Australia, National Institute for Mental Health Research, The Australian National University, and Swinburne University of Technology.
authors: Britt
authors: B
authors: Klein
authors: Macquarie University.
authors: Nickolai
authors: N
authors: Titov
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D001315:Australia; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D019057:Quality-Adjusted Life Years; D013315:Stress, Psychological / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome
keywords: anxiety; cognitive behavior therapy (CBT); cost-effectiveness; internet; older adults