TY  - INPR
Y1  - 2022/12/26/
AV  - public
TI  - Long-term clinical and cost-effectiveness of a therapist-supported online remote behavioural intervention for tics in children and adolescents: extended 12- and 18-month follow-up of a single-blind randomised controlled trial
N1  - © 2023 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
SN  - 1469-7610
PB  - Wiley-Blackwell
UR  - https://doi.org/10.1111/jcpp.13756
ID  - discovery10161726
N2  - Background
Little is known about the long-term effectiveness of behavioural therapy for tics. We aimed to assess the long-term clinical and cost-effectiveness of online therapist-supported exposure and response prevention (ERP) therapy for tics 12 and 18 months after treatment initiation.

Methods
ORBIT (online remote behavioural intervention for tics) was a two-arm (1:1 ratio), superiority, single-blind, multicentre randomised controlled trial comparing online ERP for tics with online psychoeducation. The trial was conducted across two Child and Adolescent Mental Health Services in England. Participants were recruited from these two sites, across other clinics in England, or by self-referral. This study was a naturalistic follow-up of participants at 12- and 18-month postrandomisation. Participants were permitted to use alternative treatments recommended by their clinician. The key outcome was the Yale Global Tic Severity Scale Total Tic Severity Score (YGTSS-TTSS). A full economic evaluation was conducted. Registrations are ISRCTN (ISRCTN70758207); ClinicalTrials.gov (NCT03483493).

Results
Two hundred and twenty-four participants were enrolled: 112 to ERP and 112 to psychoeducation. The sample was predominately male (177; 79%) and of white ethnicity (195; 87%). The ERP intervention reduced baseline YGTSS-TTSS by 2.64 points (95% CI: ?4.48 to ?0.79) with an effect size of ?0.36 (95% CI: ?0.61 to ?0.11) after 12?months and by 2.01 points (95% CI: ?3.86 to ?0.15) with an effect size of ?0.27 (95% CI -0.52 to ?0.02) after 18?months, compared with psychoeducation. Very few participants (<10%) started new tic treatment during follow-up. The cost difference in ERP compared with psychoeducation was £304.94 (?139.41 to 749.29). At 18?months, the cost per QALY gained was £16,708 for ERP compared with psychoeducation.

Conclusions
Remotely delivered online ERP is a clinical and cost-effective intervention with durable benefits extending for up to 18?months. This represents an efficient public mental health approach to increase access to behavioural therapy and improve outcomes for tics.
KW  - Tic disorders;
randomised controlled trial; long-term follow-up; exposure and response prevention; digital intervention.
A1  - Hollis, Chris
A1  - Hall, Charlotte L
A1  - Khan, Kareem
A1  - Jones, Rebecca
A1  - Marston, Louise
A1  - Le Novere, Marie
A1  - Hunter, Rachael
A1  - Andren, Per
A1  - Bennett, Sophie
A1  - Brown, Beverley J
A1  - Chamberlain, Liam
A1  - Davies, E Bethan
A1  - Evans, Amber
A1  - Kouzoupi, Natalia
A1  - McKenzie, Caitlin
A1  - Sanderson, Charlotte
A1  - Heyman, Isobel
A1  - Kilgariff, Joseph
A1  - Glazebrook, Cristine
A1  - Mataix-Cols, David
A1  - Serlachius, Eva
A1  - Murray, Elizabeth
A1  - Murphy, Tara
JF  - Journal of Child Psychology and Psychiatry
ER  -