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Cost-Effectiveness of Treatment Alternatives for Treatment-Refractory Pediatric Obsessive-Compulsive Disorder

Sean T Gregory1, Brian Kay2, Bradley C Riemann2

  • 1Department of Politics & International Affairs, College of Social and Behavioral Sciences, Northern Arizona University, Flagstaff, AZ, United States; Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.

Journal of Anxiety Disorders
|December 22, 2019
PubMed

Insights

Intensive Outpatient Programs (IOP) are the most cost-effective treatment for pediatric obsessive-compulsive disorder (OCD) non-responsive to initial therapies. This approach shows superior outcomes and increased access to high-dose cognitive-behavioral therapy (CBT).

Area of Science:

  • Child and Adolescent Psychiatry
  • Mental Health Services Research
  • Health Economics

Background:

  • First-line treatments for childhood obsessive-compulsive disorder (OCD) include cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) and/or serotonin reuptake inhibitor (SRI) pharmacotherapy.
  • Current first-line treatments show similar clinical effectiveness, making cost-effectiveness a key factor in treatment decisions.

Purpose of the Study:

  • To conduct a cost-effectiveness analysis (CEA) of intensive outpatient (IOP) and partial hospitalization programs (PHP) for treatment-refractory pediatric OCD.
  • To evaluate the additional benefits and costs associated with higher-intensity combination therapies for pediatric OCD.

Main Methods:

  • Cost-effectiveness analysis comparing IOP, PHP, CBT monotherapy with ADM, CBT monotherapy with additional CBT, and ADM-only with CBT.
  • Evaluation of treatment effectiveness based on changes in the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS).

Main Results:

  • Intensive Outpatient Programs (IOP) demonstrated the highest cost-effectiveness, with a mean CY-BOCS improvement of 16.42 units.
  • Partial Hospitalization Programs (PHP) and CBT monotherapy augmented with ADM showed comparable effectiveness (15.56 and 14.75 CY-BOCS units, respectively).
  • IOP achieved superior cost-effectiveness with an Incremental Cost-Effectiveness Ratio (ICER) of $48,834, below established willingness-to-pay thresholds.

Conclusions:

  • High-dosage CBT strategies, particularly IOP, are superior for youth with treatment-non-responsive pediatric OCD.
  • There is a critical need to improve access to high-fidelity, high-dose CBT combined with pharmacotherapy for pediatric OCD patients.
Abstract

Keywords:
Antidepressant MedicationCognitive Behavioral TherapyCost-EffectivenessObsessive-Compulsive DisorderTreatment-refractory

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