背景:强迫症(OCD)是一种常见的慢性精神疾病,致残率高。基于互联网的认知行为疗法(ICBT)使患者可以获得在线治疗,并已被证明是有效的。然而,ICBT三臂试验,面对面认知行为团体治疗(CBGT),只有药物仍然缺乏。
目的:本研究是一项随机研究,控制,3组强迫症评估方盲试验:ICBT联合药物治疗,CBGT联合用药,和常规医疗(即,照常治疗[TAU])。本研究旨在探讨与CBGT和TAU相关的ICBT对中国成人强迫症的疗效和成本效益。
方法:总共,选择了99例强迫症患者,并随机分配到ICBT,CBGT,和TAU组治疗6周。主要结果是耶鲁-布朗强迫症量表(YBOCS)和佛罗里达强迫症自评量表(FOCI)。在基线比较,治疗期间(3周),治疗后(6周),分析疗效。次要结果是EuroQol5D问卷(EQ-5D)的EuroQol视觉模拟量表(EQ-VAS)得分。记录成本问卷以分析成本效益。
结果:重复测量方差分析用于数据分析,最终有效样本量为93(ICBT:n=32,34.4%;CBGT:n=28,30.1%;TAU:n=33,35.5%)。治疗6周后,3组的YBOCS评分显著降低(P<.001),组间无显著差异。治疗后ICBT(P=.001)和CBGT(P=.035)组的FOCI评分明显低于TAU组。CBGT集团的总成本(人民币[RMB]6678.45,95%CI4460.88-8896.01[美元1010.36,95%CI678.87-1345.84])明显高于ICBT集团(人民币3308.81,95%CI2476.89-4140.73[美元500.58,95%CI374.72-626.43],P<.001)和TAU组(人民币2259.61元,95%CI2074.16-2445.05[341.85美元,95%CI313.79-369.90],治疗后P<.001)。ICBT小组在YBOCS评分中每减少一个单位的花费比CBGT组少303.19元(45.97美元),比TAU组少11.57元(1.75美元)。
结论:治疗师指导的ICBT联合药物治疗强迫症与面对面CBGT联合药物治疗同样有效。ICBT联合药物治疗比CBGT联合药物治疗和常规药物治疗更具成本效益。当无法使用面对面的CBGT时,对于患有强迫症的成年人来说,它有望成为一种有效且经济的选择。
背景:中国临床试验注册中心ChiCTR1900023840;https://www.chictr.org.cn/showproj.html?proj=39294。
Obsessive-compulsive disorder (OCD) is a common and chronic mental illness with a high rate of disability. Internet-based cognitive behavioral therapy (ICBT) makes online treatment available to patients and has been shown to be effective. However, 3-arm trials on ICBT, face-to-face cognitive behavioral group therapy (CBGT), and only medication are still lacking.
This study is a randomized, controlled, assessor-blinded trial of 3 groups for OCD: ICBT combined with medication, CBGT combined with medication, and conventional medical treatment (ie, treatment as usual [TAU]). The study aims to investigate the efficacy and cost-effectiveness of ICBT related to CBGT and TAU for adults with OCD in
China.
In total, 99 patients with OCD were selected and randomly assigned to the ICBT, CBGT, and TAU groups for treatment for 6 weeks. The primary outcomes were the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the self-rating Florida Obsessive-Compulsive Inventory (FOCI), compared at baseline, during treatment (3 weeks), and after treatment (6 weeks), to analyze efficacy. The secondary outcome was the EuroQol Visual Analogue Scale (EQ-VAS) scores of the EuroQol 5D Questionnaire (EQ-5D). The cost questionnaires were recorded to analyze cost-effectiveness.
Repeated-measures ANOVA was used for data analysis, and the final effective sample size was 93 (ICBT: n=32, 34.4%; CBGT: n=28, 30.1%; TAU: n=33, 35.5%). After 6-week treatment, the YBOCS scores of the 3 groups significantly decreased (P<.001), and there were no significant differences among groups. The FOCI score of the ICBT (P=.001) and CBGT (P=.035) groups was significantly lower than that of the TAU group after treatment. The total cost of the CBGT group (renminbi [RMB] 6678.45, 95% CI 4460.88-8896.01 [US $1010.36, 95% CI 678.87-1345.84]) was significantly higher than that of the ICBT group (RMB 3308.81, 95% CI 2476.89-4140.73[US $500.58, 95% CI 374.72-626.43], P<.001) and the TAU group (RMB 2259.61, 95% CI 2074.16-2445.05 [US $341.85, 95% CI 313.79-369.90], P<.001) after treatment. The ICBT group spent RMB 303.19 (US $45.97) less than the CBGT group and RMB 11.57 (US $1.75) less than the TAU group for each unit reduction in the YBOCS score.
Therapist-guided ICBT combined with medication is as effective as face-to-face CBGT combined with medication for OCD. ICBT combined with medication is more cost-effective than CBGT combined with medication and conventional medical treatment. It is expected to become an efficacious and economic alternative for adults with OCD when face-to-face CBGT is not available.
Chinese Clinical Trial Registry ChiCTR1900023840; https://www.chictr.org.cn/showproj.html?proj=39294.