{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T08:08:06Z","timestamp":1770883686847,"version":"3.50.1"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,26]],"date-time":"2022-01-26T00:00:00Z","timestamp":1643155200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonmW","doi-asserted-by":"publisher","award":["531001205"],"award-info":[{"award-number":["531001205"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>A previous randomized controlled trial in older adults with anxiety symptoms found no differences between a brief blended Acceptance and Commitment Therapy (ACT) intervention and brief face-to-face Cognitive Behavior Therapy (CBT) regarding anxiety symptom severity at posttreatment and 12-month follow-up. A health-economic evaluation comparing these interventions has not yet been conducted.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This study examined the one-year cost-effectiveness and cost-utility of blended ACT compared to face-to-face CBT for older adults with anxiety symptoms.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The economic evaluation was embedded in a randomized controlled trial comparing blended ACT to CBT in 314 older adults with mild to moderately severe anxiety symptoms. Data were collected at baseline and 3, 6 and 12 months post baseline. For the cost-effectiveness analysis, treatment response was defined as a reliable improvement in anxiety symptom severity (measured with the Generalized Anxiety Disorder-7) between baseline and 12-month follow-up. To assess cost-utility, quality-adjusted life years (QALYs) were computed using EuroQol-5 Dimensions-5 Levels-5 utility scores. Analyses took the societal perspective, including both healthcare costs and productivity costs. Incremental cost-effectiveness ratios were calculated using 2500 bootstraps of seemingly unrelated regression equations of costs and effects. Sensitivity analyses were performed to assess the robustness of the findings.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Differences between the blended ACT group and CBT group in treatment response and QALYs were statistically insignificant and clinically irrelevant. The ACT intervention was associated with an average per-participant cost reduction of \u20ac466 ($593) compared to CBT, which resulted from lower productivity costs in the blended ACT group. From a healthcare perspective, the ACT intervention was associated with higher costs (by \u20ac71 ($90)) than CBT.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The results do not indicate that from a health-economic perspective blended ACT should be preferred over CBT in the treatment of older adults with anxiety symptoms. The findings support a model of shared decision making, where clinicians and patients collaboratively decide on the preferred intervention, based on ethical-medical, practical and personal considerations.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p>Netherlands Trial Register: TRIAL <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.trialregister.nl\/trial\/6131\" xlink:type=\"simple\">NL6131<\/jats:ext-link> (NTR6270); <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.trialregister.nl\/trial\/6131\" xlink:type=\"simple\">https:\/\/www.trialregister.nl\/trial\/6131<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0262220","type":"journal-article","created":{"date-parts":[[2022,1,26]],"date-time":"2022-01-26T18:31:03Z","timestamp":1643221863000},"page":"e0262220","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Cost-effectiveness and cost-utility of an Acceptance and Commitment Therapy intervention vs. a Cognitive Behavioral Therapy intervention for older adults with anxiety symptoms: A randomized controlled trial"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9580-556X","authenticated-orcid":true,"given":"Maartje","family":"Witlox","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivian","family":"Kraaij","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadia","family":"Garnefski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernst","family":"Bohlmeijer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filip","family":"Smit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Spinhoven","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,1,26]]},"reference":[{"key":"pone.0262220.ref001","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.arr.2012.09.004","article-title":"The prevalence of mental disorders in older people in Western countries\u2013a meta-analysis","volume":"12","author":"J Volkert","year":"2013","journal-title":"Age Res Rev"},{"key":"pone.0262220.ref002","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/da.20653","article-title":"Anxiety disorders in older adults: a comprehensive review","volume":"27","author":"KB Wolitzky-Taylor","year":"2010","journal-title":"Depress Anxiety"},{"key":"pone.0262220.ref003","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1017\/S0033291799008351","article-title":"Consequences of anxiety in older persons: Its effect on disability well-being and use of health services","volume":"29","author":"E de Beurs","year":"1999","journal-title":"Psychol Med"},{"key":"pone.0262220.ref004","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1097\/JGP.0b013e3181ff416c","article-title":"The impact of DSM-IV symptom and clinical significance criteria on the prevalence estimates of subthreshold and threshold anxiety in the older adult population","volume":"19","author":"S Grenier","year":"2011","journal-title":"Am J Geriatr Psychiatry"},{"key":"pone.0262220.ref005","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1002\/gps.5221","article-title":"Association of the cumulative burden of late\u2010life anxiety and depressive symptoms with functional impairment","volume":"35","author":"A Simning","year":"2020","journal-title":"Int J Geriatr Psychiatry"},{"key":"pone.0262220.ref006","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jad.2018.02.011","article-title":"A systematic review of the association of anxiety with health care utilization and costs in people aged 65 years and older","volume":"232","author":"JK Hohls","year":"2018","journal-title":"J Affect Disord"},{"issue":"6","key":"pone.0262220.ref007","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.jagp.2012.12.016","article-title":"The excess healthcare costs associated with depression and anxiety in elderly living in the community","volume":"21","author":"HM Vasiliadis","year":"2013","journal-title":"Am J Geriatr Psychiatry"},{"key":"pone.0262220.ref008","unstructured":"World Health Organization. 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