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

Chronic pain and depression are frequently comorbid conditions associated with significant healthcare and social costs. This study examined 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 complement to treatment-as-usual (TAU), for patients with chronic low back pain (CLBP) plus depressive symptoms, compared to TAU alone. A trial-based economic evaluation (n = 234) was conducted from a governmental and healthcare perspective with a time horizon of 12 months. Primary outcomes were the Brief Pain Inventory-Interference Scale (BPI-IS) and Quality Adjusted Life Year (QALY). 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. In conclusion, ACT and BATD might be efficient options in the management of CLBP plus comorbid depression symptoms as compared to usual care. However, no clear difference was found in the comparison between the two active therapies regarding cost-effectiveness or cost-utility. PERSPECTIVE: The economic evaluation of psychological therapies for the management of complex conditions is crucial as can be used in decision-making and resource allocation. This study provides evidence that videoconference group-based forms of ACT and BATD are more effective and involve a greater reduction in costs than usual care in the management of CLBP plus comorbid depressive symptoms. Both psychological therapies seem to offer good value for money to the Spanish national health service and the government.