Economic evalua-on of digitally supported therapy for people with psychosis who hear distressing voices: the AVATAR 2 trial

Background<br/>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 multi-centre randomised controlled trial comparing brief (AV-BRF) and extended (AV-EXT) forms of therapy to treatment as usual (TAU). There was evidence for the effectiveness of therapy, particularly AV-EXT. However, value for money needs to be assessed.<br/>Aims<br/>To separately compare the cost-utility of brief and extended forms of AVATAR therapy to treatment as usual.<br/>Method<br/>In a three-arm randomised controlled trial, the use of health services was measured and costs (2021/2 £s) calculated form a health and social care perspective over a 28-week follow-up period. Quality-adjusted life years (derived from the EQ-5D-5L) were combined with costs.<br/>Results<br/>AV-BRF resulted in extra costs of £319 (95% CI, -£1558 to £2496) and AV-EXT in lower costs of £1965 (95% CI, -£1912 to £1519) compared to TAU. Over the follow-up, AVBRF resulted in 0.0159 (95% CI, -0.0103 to 0.0422) and AV-EXT in 0.0173 (95% CI, - 0.0049 to 0.0395) more QALYs than TAU. The cost per QALY for AV-BRF compared to TAU is £20,016 while AV-EXT dominated TAU (lower costs and more QALYs).<br/>Conclusions<br/>Neither version of AVATAR had a substantial impact on QALYs. However, the AV-EXT did result in reduced care costs albeit not statistically significant and was potentially cost-effective compared to TAU. AV-BRF had an ICER that indicated lower potential cost-effectiveness. These findings are uncertain but could still inform decision making regarding interventions in this field.