Andersson et al. BMC Public Health 2011, 11:215 http://www.biomedcentral.com/1471-2458/11/215 R E S E A R C H A R T I C L E Open Access Cost-effectiveness of internet-based cognitive behavior therapy for irritable bowel syndrome: results from a randomized controlled trial Erik Andersson1*, Brjánn Ljótsson1, Filip Smit2,3, Björn Paxling2,3,4, Erik Hedman1, Nils Lindefors1, Gerhard Andersson1,4 and Christian Rück1 Abstract Background: Irritable Bowel Syndrome (IBS) is highly prevalent and is associated with a substantial economic burden. Cognitive behavior therapy (CBT) has been shown to be effective in treating IBS. The aim of this study was to evaluate the cost-effectiveness of a new treatment alternative, internet-delivered CBT based on exposure and mindfulness exercises. Methods: Participants (N = 85) with IBS were recruited through self-referral and were assessed via a telephone interview and self-report measures on the internet. Participants were randomized to internet-delivered CBT or to a discussion forum. Economic data was assessed at pre-, post- and at 3-month and 1 year follow-up. Results: Significant cost reductions were found for the treatment group at $16,806 per successfully treated case. The cost reductions were mainly driven by reduced work loss in the treatment group. Results were sustained at 3-month and 1 year follow-up. Conclusions: Internet-delivered CBT appears to generate health gains in IBS treatment and is associated with cost- savings from a societal perspective. Keywords: Cognitive behavior therapy internet, IBS, cost-effectiveness analysis Background Irritable bowel syndrome (IBS) is a highly prevalent gas- trointestinal disorder [1] that is associated with produc- tion losses [2,3] and increased levels of health service utilization [3,4]. The high prevalence rate combined with the costs associated for each afflicted individual makes IBS a considerable economic burden for society. Research indicates that psychological interventions - such as cogni- tive behavior therapy (CBT), hypnotherapy and psycho- dynamic therapy - can be effective in reducing IBS symptoms [5]. In addition, there is some evidence indi- cating that psychological treatments are cost-effective. In a study by Creed et al. [6], 171 patients with IBS were randomized to receive either 8 sessions of individual psychodynamic therapy, paroxetine, or care as usual. * Correspondence: erik.m.andersson@ki.se 1Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden Full list of author information is available at the end of the article At one-year follow-up, the psychotherapy condition was associated with significant reductions in health care con- sumption when compared to care as usual, whereas the paroxetine group did not show a similar reduction. In a study by McCrone et al. [7], CBT was found to have a reasonable short-term cost-effectiveness but not beyond 3-month follow-up. In summary, although psychological treatments are effective in reducing IBS symptoms there is insufficient evidence of their cost-effectiveness. Our research group has recently conducted a rando- mized controlled trial of internet-delivered CBT for IBS [8]. The main reason for using the internet as method of delivery is to increase the availability of the treatment. Evidence-based psychological treatments are often una- vailable due to a lack of properly trained therapists [9]. Internet-delivered CBT with minimal therapist contact has been found to be effective for a number of psychiatric and somatic problems [10,11], and are likely to be cost- effective and more accessible to patients [12]. However, © 2011 Andersson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.