Evidence map›Paper›PMID 41392761›Full record

ArticleBJPsych open2025

Economic evaluation of digitally supported therapy for people with psychosis who hear distressing voices: the AVATAR2 trial.

Paul McCrone, Evdoxia Gkaintatzi, Thomas Ward, Clementine J Edwards, Hassan Jafari, Richard Emsley, Mark Huckvale, Mar Rus-Calafell, Miriam Fornells-Ambrojo, Andrew Gumley and 11 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BJPsych open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Paul McCroneInstitute for Lifecourse Development, https://ror.org/00bmj0a71University of Greenwich, London, UK.ORCID https://orcid.org/0000-0001-7001-4502
Evdoxia GkaintatziInstitute for Lifecourse Development, https://ror.org/00bmj0a71University of Greenwich, London, UK.
Thomas WardDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Clementine J EdwardsDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.ORCID https://orcid.org/0000-0001-9949-2401
Hassan JafariDepartment of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Richard EmsleyDepartment of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Mark HuckvaleDepartment of Speech, Hearing and Phonetic Sciences, University College London, London, UK.
Mar Rus-CalafellDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Miriam Fornells-AmbrojoResearch Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Andrew GumleySchool of Health & Wellbeing, University of Glasgow, Glasgow, UK.
Gillian HaddockDivision of Psychology and Mental Health, School of Health Sciences, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK.
Sandra BucciDivision of Psychology and Mental Health, School of Health Sciences, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK.
Hamish J McLeodSchool of Health & Wellbeing, University of Glasgow, Glasgow, UK.ORCID https://orcid.org/0000-0002-4225-1815
Jeffrey McDonnellResearch Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Moya ClancySchool of Health & Wellbeing, University of Glasgow, Glasgow, UK.
Michael FitzsimmonsDivision of Psychology and Mental Health, School of Health Sciences, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK.
Alice MontagueResearch Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Nikos XanidisSchool of Health & Wellbeing, University of Glasgow, Glasgow, UK.
Hannah BallDivision of Psychology and Mental Health, School of Health Sciences, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK.ORCID https://orcid.org/0000-0002-1178-5080
Thomas K J CraigSouth London & Maudsley NHS Foundation Trust, London, UK.ORCID https://orcid.org/0000-0003-1442-0391
Philippa A GaretyDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAVATAR 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.

aimsTo compare separately the cost utility of the brief and extended forms of AVATAR therapy with TAU.

methodIn 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.

resultsAV-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).

conclusionsNeither 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.

Indexed as

auditory hallucinationsCost-effectivenesspsychological supportpsychosisquality-adjusted life years

Identifiers

PMID41392761
PMCPMC12724094

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.