McCrone, Paul ORCID: https://orcid.org/0000-0001-7001-4502, Gkaintatzi, Evdoxia, Ward, Thomas, Edwards, Clementine J. ORCID: https://orcid.org/0000-0001-9949-2401, Jafari, Hassan, Emsley, Richard, Huckvale, Mark, Rus-Calafell, Mar, Fornells-Ambrojo, Miriam, Gumley, Andrew, Haddock, Gillian, Bucci, Sandra, McLeod, Hamish J. ORCID: https://orcid.org/0000-0002-4225-1815, McDonnell, Jeffrey, Clancy, Moya, Fitzsimmons, Michael, Montague, Alice, Xanidis, Nikos, Ball, Hannah ORCID: https://orcid.org/0000-0002-1178-5080, Craig, Thomas K. J. ORCID: https://orcid.org/0000-0003-1442-0391 and Garety, Philippa A. (2025) Economic evaluation of digitally supported therapy for people with psychosis who hear distressing voices: the AVATAR2 trial. BJPsych Open, 12 (1):e13. pp. 1-8. ISSN 2056-4724 (Online) (doi:10.1192/bjo.2025.10925)

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Abstract

Background
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.
Aims
To compare separately the cost utility of the brief and extended forms of AVATAR therapy with TAU.
Method
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.
Results
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 with TAU. Over the follow-up, AV-BRF 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 with TAU was £20 016, while AV-EXT dominated TAU (lower costs and more QALYs).
Conclusions
Neither version of AVATAR had a substantial impact on QALYs. However, AV-EXT did result in reduced care costs − albeit not statistically significant − 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.

Item Type:	Article
Uncontrolled Keywords:	cost-effectiveness, psychosis, auditory hallucinations, quality adjusted life years, psychological support
Subjects:	R Medicine > R Medicine (General) R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Mental Health Faculty of Education, Health & Human Sciences > School of Health Sciences (HEA)
Last Modified:	06 Jan 2026 14:23
URI:	https://gala.gre.ac.uk/id/eprint/52036

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