{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:50:03Z","timestamp":1785433803603,"version":"3.56.0"},"reference-count":27,"publisher":"Royal College of Psychiatrists","issue":"1","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec id=\"S2056472425109253_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>AVATAR therapy, a digitally supported intervention, utilises avatars to promote recovery in people who experience distressing auditory hallucinations. This approach was recently evaluated in a multicentre randomised controlled trial comparing brief (AV-BRF) and extended (AV-EXT) forms of therapy with treatment as usual (TAU). There was evidence for the effectiveness of therapy, particularly for AV-EXT. However, value for money needs to be assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472425109253_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To compare separately the cost utility of the brief and extended forms of AVATAR therapy with TAU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472425109253_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>In a three-arm randomised controlled trial the use of health services was measured, and costs (2021\/2022; pounds sterling) calculated from a health and social care perspective over a 28-week follow-up period. Quality-adjusted life years (QALYs; derived from the 5-level version of the EuroQol 5-Dimension questionnaire) were combined with costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472425109253_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>AV-BRF resulted in extra costs of \u00a3319 (95% CI, \u2212\u00a31558 to \u00a32496), and AV-EXT in lower costs of \u00a31965 (95% CI, \u2212\u00a31912 to \u00a31519), compared with TAU. Over the follow-up, AV-BRF resulted in 0.0159 (95% CI, \u22120.0103 to 0.0422) and AV-EXT in 0.0173 (95% CI, \u22120.0049 to 0.0395) more QALYs than TAU. The cost per QALY for AV-BRF compared with TAU was \u00a320 016, while AV-EXT dominated TAU (lower costs and more QALYs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472425109253_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Neither version of AVATAR had a substantial impact on QALYs. However, AV-EXT did result in reduced care costs \u2212 albeit not statistically significant \u2212 and was potentially cost-effective compared with TAU. AV-BRF had an incremental cost-effectiveness ratio that indicated lower potential cost-effectiveness. These findings are uncertain, but could still inform decision-making regarding interventions in this field.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2025.10925","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T09:19:30Z","timestamp":1765790370000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Economic evaluation of digitally supported therapy for people with psychosis who hear distressing voices: the AVATAR2 trial"],"prefix":"10.1192","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7001-4502","authenticated-orcid":false,"given":"Paul","family":"McCrone","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00bmj0a71","id-type":"ROR","asserted-by":"publisher"}],"name":"University of 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