Review for 10.1186/s12876-021-01848-9 (2021)

Reviewer’s report
Title: 
Cost effectiveness of therapist delivered cognitive behavioural therapy and
web-based self-management in irritable bowel syndrome: the ACTIB
randomised trial
Version: 
1 
Date: 
05 Feb 2021
Reviewer's report:
The Authors have recently demonstrated that both telephone-delivered cognitive-
behavioural therapy (TCBT) plus treatment as usual (TAU) and web-based
cognitive behavioural therapy (WCBT) plus TAU were superior to TAU in terms
of improvements in the primary outcomes, IBS symptom severity and impact of
IBS on life roles (daily functioning) up to 12 months follow-up. They were also
superior on a range of secondary outcomes (global symptom relief, anxiety,
depression, and cognition). in patients with IBS 
that underwent the ACTIB
randomised trial. 
In this paper, McCrone et al. aimed to investigate the differences in health
service and societal costs between participants allocated to the three arms of the
ACTIB randomized trial 
and compare the cost-effectiveness of TCBT+ TAU 
and
WCBT+ TAU 
compared to TAU in terms of quality-adjusted life years
(QALYs) over the 12-month follow-up in IBS patients 
Their results showed that TCBT and WCBT resulted in more QALYs and
increased healthcare costs over the follow-up period compared to TAU. 
Imputation for missing data resulted in a reduction of cost-effectiveness
however, the cost per QALY for WCBT was lower than the threshold often
assumed to guide NICE decisions in England. TCBT on the other hand had a
costeffectiveness ratio slightly above this threshold. 
Moreover, both TCBT and
WCBT resulted in lower societal costs than TAU. 
Comments
In my opinion this is a very interesting study that could strongly impact on
guidelines recommendations .
A concern is the quantity of missing EQ-5D-5L data, that was the main outcome
measure, However, the Authors addressed this point in the limitations of the
study. Moreover, they demonstrated that 
using imputation method the web-based
CBT intervention remained cost-effective. 
I suggest to better underline the strenghts of this study in the discussion
especially the point that both interventions appear to produce important savings
in terms of carer costs that NICE do not usually consider in their decision-
making process. 
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