Irritable bowel syndrome (IBS) is a debilitating and costly disorder. Cognitive behavior therapy (CBT) is effective in the treatment of IBS, both when delivered over the internet and in face-to-face settings. CBT consists of different components and little is known about their relative importance. We have in an earlier study showed that inclusion of exposure in the CBT for IBS makes it even more effective. In the present study we wanted to evaluate the economic effects for society of inclusion vs exclusion of exposure in an internet delivered CBT for IBS. We used data from a previous study with 309 participants with IBS. Participants were randomized to internet delivered CBT with (ICBT) or without exposure (ICBT-WE). We compared direct and indirect costs at baseline, after treatment, and 6 months after treatment (primary endpoint; 6MFU). Data was also collected on symptom severity and time spent by therapists and participants. The relative Incremental Cost Effectiveness Ratio (ICER) was calculated for the two treatment conditions and the return on investment (ROI). Results showed that ICBT cost $213.5 (20%) more than ICBT-WE per participant. However, ICBT was associated with larger reductions regarding both costs and symptoms than ICBT-WE at 6MFU. The ICER was − 301.69, meaning that for every point improvement on the Gastrointestinal Symptom Rating Scale—IBS version in ICBT, societal costs would be reduced with approximately $300. At a willingness to pay for a case of clinically significant improvement in IBS symptoms of $0, there was an 84% probability of cost-effectiveness. ROI analysis showed that for every $1 invested in ICBT rather than ICBT-WE, the return would be $5.64 six months after treatment. Analyses of post-treatment data showed a similar pattern although cost-savings were smaller. Including exposure in Cognitive Behavior Treatment for IBS is more cost-effective from a societal perspective than not including it, even though it may demand more therapist and patient time in the short term. This study is reported in accordance with the CONSORT statement for non-pharmacological trials [1]. Clinicaltrials.gov registration ID: NCT01529567 (14/02/2013).

中文翻译：

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肠易激综合征互联网暴露疗法的投资回报：一项随机对照试验

肠易激综合征 (IBS) 是一种使人虚弱且代价高昂的疾病。认知行为疗法 (CBT) 可有效治疗 IBS，无论是通过互联网还是在面对面的环境中进行。CBT 由不同的组成部分组成，但对其相对重要性知之甚少。我们在较早的一项研究中表明，将暴露纳入 IBS 的 CBT 使其更加有效。在本研究中，我们想评估在互联网交付的 IBS CBT 中，包容社会与排除暴露对经济影响。我们使用了先前对 309 名 IBS 参与者进行的研究的数据。参与者被随机分配到互联网提供的 CBT（ICBT）或不暴露（ICBT-WE）。我们比较了基线、治疗后和治疗后 6 个月的直接和间接成本（主要终点；6MFU）。还收集了治疗师和参与者的症状严重程度和时间的数据。计算了两种处理条件和投资回报 (ROI) 的相对增量成本效益比 (ICER)。结果显示，每位参与者 ICBT 的成本比 ICBT-WE 高 213.5 美元（20%）。然而，与 6MFU 的 ICBT-WE 相比，ICBT 在成本和症状方面的降低幅度更大。ICER 为 − 301.69，这意味着胃肠道症状评定量表（ICBT 中的 IBS 版本）每提高一点，社会成本就会降低约 300 美元。如果愿意为 0 美元的 IBS 症状临床显着改善付费，则成本效益的可能性为 84%。投资回报率分析表明，每向 ICBT 而非 ICBT-WE 投资 1 美元，回报将为 5 美元。64 治疗后六个月。对治疗后数据的分析显示出类似的模式，但节省的成本较小。从社会角度来看，在 IBS 的认知行为治疗中包括暴露比不包括它更具成本效益，尽管它可能在短期内需要更多的治疗师和患者时间。本研究根据非药物试验的 CONSORT 声明进行报告 [1]。Clinicaltrials.gov 注册 ID：NCT01529567 (14/02/2013)。本研究根据非药物试验的 CONSORT 声明进行报告 [1]。Clinicaltrials.gov 注册 ID：NCT01529567 (14/02/2013)。本研究根据非药物试验的 CONSORT 声明进行报告 [1]。Clinicaltrials.gov 注册 ID：NCT01529567 (14/02/2013)。