Background Irritable bowel syndrome (IBS) is a common, often disabling gastrointestinal (GI) disorder for which there is no satisfactory medical treatment but is responsive to cognitive behavior therapy (CBT). Purpose To evaluate the costs and cost-effectiveness of a minimal contact version of CBT (MC-CBT) condition for N = 145 for IBS relative to a standard, clinic-based CBT (S-CBT; N = 146) and a nonspecific comparator emphasizing education/support (EDU; N = 145). Method We estimated the per-patient cost of each treatment condition using an activity-based costing approach that allowed us to identify and estimate costs for specific components of each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of MC-CBT relative to S-CBT and EDU. We then evaluated the cost-effectiveness of MC-CBT relative to these alternatives for selected outcomes at immediate posttreatment and 6 months posttreatment, using both an intent-to-treatment and per-protocol methodology. Key outcomes included scores on the Clinical Global Impressions-Improvement Scale and the percentage of patients who positively responded to treatment. Results The average per-patient cost of delivering MC-CBT was $348, which was significantly less than the cost of S-CBT ($644) and EDU ($457) (p < .01). Furthermore, MC-CBT produced better average patient outcomes at immediate and 6 months posttreatment relative to S-CBT and EDU (p < .01). The current findings indicated that MC-CBT is a cost-effective option relative to S-CBT and EDU. Conclusion As predicted, MC-CBT was delivered at a lower cost per patient than S-CBT and performed better over time on the primary outcome of global IBS symptom improvement.

中文翻译：

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肠易激综合征的最小接触与标准认知行为疗法：多中心试验的成本效益结果

背景 肠易激综合征 (IBS) 是一种常见的、经常致残的胃肠道 (GI) 疾病，目前尚无令人满意的药物治疗，但对认知行为疗法 (CBT) 有反应。目的 相对于基于临床的标准 CBT (S-CBT; N = 146) 和非特异性比较器，评估 IBS 的 N = 145 的最小接触 CBT (MC-CBT) 条件的成本和成本效益强调教育/支持（EDU；N = 145）。方法 我们使用基于活动的成本核算方法估算每种治疗条件的每位患者成本，该方法使我们能够识别和估算每种干预措施的特定组成部分的成本以及总体总成本。使用简单均值分析和多元回归模型，我们估计了 MC-CBT 相对于 S-CBT 和 EDU 的增量有效性。然后，我们使用意向治疗和符合方案的方法评估了 MC-CBT 相对于这些替代方案在治疗后立即和治疗后 6 个月的选定结果的成本效益。主要结果包括临床全球印象改善量表的得分和对治疗有积极反应的患者百分比。结果 实施 MC-CBT 的每位患者平均成本为 348 美元，显着低于 S-CBT（644 美元）和 EDU（457 美元）的成本（p < .01）。此外，相对于 S-CBT 和 EDU，MC-CBT 在即刻和治疗后 6 个月产生更好的平均患者结果（p < .01）。目前的研究结果表明，相对于 S-CBT 和 EDU，MC-CBT 是一种具有成本效益的选择。结论 正如预测的那样，