Background & Aims

Chronic low back pain (CLBP) and depression are prevalent comorbid conditions related to significant healthcare and societal costs. The present study analyzed the cost-utility and cost-effectiveness of videoconference-based group forms of Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD), as a coadjuvant to treatment-as-usual (TAU), for Spanish patients with CLBP plus clinically relevant depressive symptoms, compared to TAU alone.

Methods

An economic evaluation embedded within a randomized, controlled trial was conducted from a governmental and healthcare perspective with a time horizon of 12 months. Participants were randomly assigned to ACT, BATD, or TAU. Primary outcomes were the Brief Pain Inventory–Interference Scale (BPI-IS) and Quality Adjusted Life Years (QALYs). The analyzed sample was composed of 234 adult patients (68% women, mean age= 55 years-old) with CLBP plus depression.

Results

Compared to TAU, ACT achieved a significant reduction in total costs (d = 0.47), and BATD achieved significant reductions in indirect (d = 0.61) and total costs (d = 0.63). Significant improvements in BPI-IS (d = 0.73 and d = 0.66, respectively) and QALY scores (d = 0.46 and d = 0.28, respectively) were found in ACT and BATD compared to TAU. No significant differences in costs and outcomes were found between ACT and BATD. In the intention-to-treat analyses, from the governmental and healthcare perspective, no significant differences in cost reduction and incremental effects were identified in the comparison between ACT, BATD, and TAU. However, in the complete case analysis, significant incremental effects of ACT (?BPI-IS = -1.57 and -1.39, respectively) and BATD (?BPI-IS = -1.08 and -1.04, respectively) compared with TAU were observed. In the per-protocol analysis, only the significant incremental effects of ACT (?BPI-IS = -1.68 and -1.43, respectively) compared to TAU were detected.

Conclusions

The findings of this study indicate that videoconference ACT or BATD for people with CLBP and clinically relevant depression symptoms are more effective and involve a greater reduction in costs than usual care. In public healthcare systems, there are many competing demands and limited resources to address these demands. These results suggest that investment in new forms of CBT delivered via videoconferencing for individuals with CLBP plus depression represents good value for money compared to usual care. Even though the results are promising, it is important to consider that the therapies were delivered in a pandemic context with high social restrictions. The unprecedented context of this study is relevant for the interpretation of the scope and limitations of the results. For this reason, it is recommended that future studies continue to seek evidence for the cost-utility and cost-effectiveness of these therapies administered in group format and via videoconferencing.

References

– Lai L, Liu Y, McCracken LM, Li Y, Ren Z. The efficacy of Acceptance and Commitment Therapy for chronic pain: A three-level meta-analysis and a trial sequential analysis of randomized controlled trials. Behav Res Ther 2023; 165: 104308.
– Sanabria-Mazo JP, Colomer-Carbonell A, Fernández-Vázquez Ó, Noboa-Rocamora G, Cardona-Ros G, McCracken LM, Montes-Pérez A, Castaño-Asins JR, Edo S, Borràs X, Sanz A, Feliu-Soler A, Luciano JV. A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress. Front Psychol. 2023; 14: 1200685.
– Sanabria-Mazo JP, Colomer-Carbonell A, Borràs X, Castaño-Asins JR, McCracken LM, Montero-Marin J, Pérez-Aranda A, Edo S, Sanz A, Feliu-Soler A, Luciano JV. Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study). J Pain. 2023; 24(8): 1522-1540.
– Sanabria-Mazo JP, D’Amico F, Cardeñosa E, Ferrer-Forés M, Edo S, Borràs X, McCracken LM, Feliu-Soler A, Sanz A, Luciano JV. Economic evaluation of videoconference group Acceptance and Commitment Therapy and Behavioral Activation Therapy for Depression versus usual care among adults with chronic low back pain plus comorbid depressive symptoms. J Pain. In press.
– Walsh S, Moseley GL, Gray RJ, et al. Use of behavioural activation to manage pain: A systematic scoping review. BMJ Open 2022; 12(6): e056404

Presenting Author

Juan P. Sanabria-Mazo

Poster Authors

Juan V. Luciano

PhD

Parc Sanitari Sant Joan de Déu & Autonomous University of Barcelona

Lead Author

Francesco D'Amico

Care Policy and Evaluation Centre, London School of Economics and Political Science, United Kingdom

Lead Author

Carla Rodríguez-Freire

MD

Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu

Lead Author

Lance McCracken

Uppsala University

Lead Author

Albert Feliu-Soler

PhD

Department of Clinical and Health Psychology, Autonomous University of Barcelona

Lead Author

Juan P. Sanabria-Mazo

MD

Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu

Lead Author

Topics

  • Treatment/Management: Pharmacology: Psychological and Rehabilitative Therapies