Witlox et al., 2022

Background: A previous randomized controlled trial in older adults with anxiety symptoms found no differences between a brief blended Acceptance and Commitment Therapy (ACT) intervention and brief face-to-face Cognitive Behavior Therapy (CBT) regarding anxiety symptom severity at posttreatment and 12-month follow-up. A health-economic evaluation comparing these interventions has not yet been conducted. Objective: This study examined the one-year cost-effectiveness and cost-utility of blended ACT compared to face-to-face CBT for older adults with anxiety symptoms. Methods: The economic evaluation was embedded in a randomized controlled trial comparing blended ACT to CBT in 314 older adults with mild to moderately severe anxiety symptoms. Data were collected at baseline and 3, 6 and 12 months post baseline. For the cost-effectiveness analysis, treatment response was defined as a reliable improvement in anxiety symptom severity (measured with the Generalized Anxiety Disorder-7) between baseline and12-month follow-up. To assess cost-utility, quality-adjusted life years (QALYs) were computed using EuroQol-5 Dimensions-5 Levels-5 utility scores. Analyses took the societal perspective, including both healthcare costs and productivity costs. Incremental cost-effectiveness ratios were calculated using 2500 bootstraps of seemingly unrelated regression equations of costs and effects. Sensitivity analyses were performed to assess the robustness of the findings. Results: Differences between the blended ACT group and CBT group in treatment response and QALYs were statistically insignificant and clinically irrelevant. The ACT intervention was associated with an average per-participant cost reduction of €466 ($593) compared to CBT, which resulted from lower productivity costs in the blended ACT group. From a healthcare perspective, the ACT intervention was associated with higher costs (by €71 ($90)) than CBT. Conclusions: The results do not indicate that from a health-economic perspective blended ACT should be preferred over CBT in the treatment of older adults with anxiety symptoms. The findings support a model of shared decision making, where clinicians and patients collaboratively decide on the preferred intervention, based on ethical-medical, practical and personal considerations. Reading the article and completing the 10-question quiz to 100%, participants will earn 1 Learning CEU.

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Course curriculum

  • 1


    • Witlox et al., 2022

  • 2


    • Quiz

  • 3


    • Evaluation


CEU Content Creator

Jacqueline Shackil

Jacqueline joined Affecting Behavior Change as a Performance Engineer Intern. We were so inspired by her dedication to the field and to helping others learn more about Organizational Behavior Management. Jacqueline continued to excel in her position and became a CEU Content Creator. As a CEU Content Creator at Affecting Behavior Change, Jacqueline develops continuing education and professional development courses on ethics, contemporary issues in Behavior Analysis, and Organizational Behavior Management. Jacqueline has an M.S. in Applied Behavior Analysis and a Graduate Certification in Industrial-Organizational Psychology. She is also a Board Certified Behavior Analyst.

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