Background: This economic evaluation supplements a pragmatic randomized controlled trial conducted in community care settings, which showed superior improvement in the symptoms of adults with anxiety disorders who received 12 sessions of transdiagnostic cognitive-behavioural group therapy in addition to treatment as usual (tCBT + TAU) compared to TAU alone.Methods: This study evaluates the cost-utility and cost-effectiveness of tCBT + TAU over an 8-month time horizon. For the reference case, quality-adjusted life years (QALYs) obtained using the EQ-5D-5L, and the health system perspective were chosen. Alternatively, anxiety-free days (AFDs), derived from the Beck Anxiety Inventory, and the limited societal perspective were considered. Unadjusted incremental cost-effectiveness/utility ratios were calculated. Net-benefit regressions were done for a willingness-to-pay (WTP) thresholds range to build cost-effectiveness acceptability curves (CEAC). Sensitivity analyses were included.Results: Compared to TAU (n = 114), tCBT + TAU (n = 117) generated additional QALYs, AFDs, and higher mental health care costs from the health system perspective. From the health system and the limited societal perspectives, at a WTP of Can$ 50 000/QALY, the CEACs showed that the probability of tCBT + TAU v. TAU being cost-effective was 97 and 89%. Promising cost-effectiveness results using AFDs are also presented. The participation of therapists from the public health sector could increase cost-effectiveness.Conclusions: From the limited societal and health system perspectives, this first economic evaluation of tCBT shows favourable cost-effectiveness results at a WTP threshold of Can$ 50 000/QALY. Future research is needed to replicate findings in longer follow-up studies and different health system contexts to better inform decision-makers for a full-scale implementation.

Aim: To assess the impact of sociodemographic factors and beliefs about medicines on the uptake of pharmacogenomic testing in older adults in a public healthcare system. Materials & methods: Data a...

Aim: To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon. Methods: Data from a pragmatic multisite randomized controlled trial where adults (18–65 years) with an anxiety disorder were randomized to tCBT + TAU ( n = 117) or TAU ( n = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method. Results: The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%. Conclusion: tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.

Nearly 20% of women will be confronted with anxiety or depressive disorders during the perinatal period and this may lead to adverse outcomes for both mother and child. Cognitive behavioural therapy (CBT) is the psychological intervention with the most empirical support for the clinical management of anxiety and depressive disorders. Anxiety and depression frequently occur in women during the perinatal period, and there is growing evidence that internet-delivered CBT (iCBT) could be an acceptable and effective intervention. THIS WAY UP, an Australian digital mental health service, has developed a program for postnatal anxiety and depression. This study protocol aims to examine the acceptability and efficacy of a French-Canadian adaptation of the program. The research team propose to conduct a mixed hybrid type 1 pragmatic randomized clinical trial and implementation study to replicate the findings of the trial conducted in Australia by Loughnan et al. (2019), as well as explore barriers and facilitators to potential large-scale implementation. TREATMENT AND CONTROL CONDITIONS: a) postnatal anxiety and depression iCBT program with three lessons to complete in a six-week period, added to treatment-as-usual (TAU); b) TAU. Participants will include French-speaking women with probable postnatal depression or anxiety as per the Generalized Anxiety Disorder-7 (GAD-7) or the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measures will be the GAD-7 and the EPDS. Secondary outcome measures will comprise self-reported instruments to evaluate psychological distress, quality of life, mother-child experience, and treatment experience. Qualitative interviews with participants and health professionals will provide insights on acceptability and delivery of the iCBT program. Statistical analysis will follow intent-to-treat principles. A mixed model regression approach will be used to account for between- and within-subject variations in the analysis of the effects of iCBT compared to TAU only intervention. The study will generate important data of efficacy and acceptability to patients, clinicians, and decision-makers to inform the scaling-up of the postnatal iCBT intervention in Canada. ClinicalTrials.gov: NCT06778096, prospectively registered on 2025/01/16.

Background/Objectives: Psilocybin-assisted therapy (PAT) is a promising intervention to alleviate existential distress among patients with advanced cancer receiving palliative care. However, evidence on how to integrate PAT into routine oncology and palliative care services remains scarce. This study aimed to examine real-world PAT implementation, identify factors influencing adoption, and estimate integration costs within oncology and palliative care services. Methods: We conducted a single-case implementation study in a large university-affiliated tertiary care center in Canada during the first year following its introduction. Semi-structured interviews with clinicians, managers, and other stakeholders explored barriers, facilitating conditions, and actions needed to support PAT implementation. A budget impact analysis estimated incremental costs associated with delivering PAT. Results: After one year, no patients had received PAT. Ten professionals representing diverse clinical and managerial roles participated in the interviews. While participants viewed PAT favorably, they emphasized the need to align the intervention with existing care pathways and clarify referral processes. Administrative and regulatory procedures, together with logistical constraints related to treatment delivery, were identified as key barriers, whereas perceived clinical relevance and institutional leadership were seen as important facilitators. From the health care system perspective, the estimated cost of delivering a complete PAT intervention ranged from 2648 to 5827 Canadian dollars (CAD) per patient, depending on the scenario examined, excluding the cost of the psilocybin itself. Conclusions: Despite perceived clinical relevance and relatively modest estimated costs, the absence of treated patients after one year highlights the gap between regulatory authorization and effective service uptake. These findings underscore the importance of structured implementation strategies, sustained institutional support, and alignment between regulatory frameworks and clinical workflows to ensure meaningful integration of PAT into routine oncology and palliative care services.