title: An economic evaluation of an augmented cognitive behavioural intervention vs. computerized cognitive training for post-stroke depressive symptoms.
abstract: BACKGROUND
  Stroke survivors encounter emotional problems in the chronic phase after stroke. Post-stroke depressive symptoms have major impact on health-related quality of life (HRQol) and lead to increased hospitalization and therefore substantial healthcare costs. We present a cost-effectiveness and cost-utility evaluation of a cognitive behavioural therapy augmented with occupational and movement therapy to support patients with a stroke with depressive symptoms in goal-setting and goal attainment (augmented CBT) in comparison with a computerized cognitive training program (CogniPlus) as a control intervention.
  
  
  METHODS
  A trial-based economic evaluation was conducted from a societal perspective with a time horizon of 12 months. Stroke patients (aged 18+ years) with signs of depression (Hospital Anxiety and Depression Scale (HADS) - subscale depression > 7) were eligible to participate. Primary outcomes were the HADS and Quality Adjusted Life Years (QALYs) based on the three-level five-dimensional EuroQol (EQ-5D-3 L). Missing data were handled through mean imputation (costs) and multiple imputation (HADS and EuroQol), and costs were bootstrapped. Sensitivity analyses were performed to test robustness of baseline assumptions.
  
  
  RESULTS
  Sixty-one patients were included. The average total societal costs were not significantly different between the control group (€9,998.3) and the augmented CBT group (€8,063.7), with a 95 % confidence interval (-5,284, 1,796). The augmented CBT intervention was less costly and less effective from a societal perspective on the HADS, and less costly and slightly more effective in QALYs, in comparison with the control treatment. The cost-effectiveness and cost-utility analyses provided greater effects and fewer costs for the augmented CBT group, and fewer effects and costs for the HADS. Based on a willingness to pay (WTP) level of €40,000 per QALY, the augmented CBT intervention had a 76 % chance of being cost-effective. Sensitivity analyses showed robustness of results.
  
  
  CONCLUSIONS
  The stroke-specific augmented CBT intervention did not show convincing cost-effectiveness results. In addition to other literature, this study provided new insights into the potential cost-effectiveness of an adjusted cognitive behavioural therapy intervention. However, as our study showed a 76 % chance of being cost-effective for one outcome measure (QALY) and did not provide convincing cost-effectiveness results on the HADS we recommend further research in a larger population.
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. mitchel.vaneeden@maastrichtuniversity.nl.|MHeNS, School for Mental Health & Neuroscience; Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands. mitchel.vaneeden@maastrichtuniversity.nl.
authors.forename: M
authors.initials: M
authors.lastname: van Eeden
authors.affiliation: Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Kootker
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: S M A A
authors.initials: SM
authors.lastname: Evers
authors.affiliation: MHeNS, School for Mental Health & Neuroscience; Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.|Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: van Heugten
authors.affiliation: Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
authors.forename: A C H
authors.initials: AC
authors.lastname: Geurts
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: G A P G
authors.initials: GA
authors.lastname: van Mastrigt
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009788:Occupational Therapy; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000523:psychology*