Cost-effectiveness of computerized cognitive-behavioural therapy for the treatment of depression in primary care: findings from the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial

TY - JOUR

T1 - Cost-effectiveness of computerized cognitive-behavioural therapy for the treatment of depression in primary care

T2 - findings from the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial

AU - Duarte, A

AU - Walker, S

AU - Littlewood, E

AU - Brabyn, S

AU - Hewitt, C

AU - Gilbody, S

AU - Palmer, S

N1 - © Cambridge University Press 2017 . This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.

PY - 2017/7

Y1 - 2017/7

N2 - BACKGROUND: Computerized cognitive-behavioural therapy (cCBT) forms a core component of stepped psychological care for depression. Existing evidence for cCBT has been informed by developer-led trials. This is the first study based on a large independent pragmatic trial to assess the cost-effectiveness of cCBT as an adjunct to usual general practitioner (GP) care compared with usual GP care alone and to establish the differential cost-effectiveness of a free-to-use cCBT programme (MoodGYM) in comparison with a commercial programme (Beating the Blues) in primary care.METHOD: Costs were estimated from a healthcare perspective and outcomes measured using quality-adjusted life years (QALYs) over 2 years. The incremental cost-effectiveness of each cCBT programme was compared with usual GP care. Uncertainty was estimated using probabilistic sensitivity analysis and scenario analyses were performed to assess the robustness of results.RESULTS: Neither cCBT programme was found to be cost-effective compared with usual GP care alone. At a £20 000 per QALY threshold, usual GP care alone had the highest probability of being cost-effective (0.55) followed by MoodGYM (0.42) and Beating the Blues (0.04). Usual GP care alone was also the cost-effective intervention in the majority of scenario analyses. However, the magnitude of the differences in costs and QALYs between all groups appeared minor (and non-significant).CONCLUSIONS: Technically supported cCBT programmes do not appear any more cost-effective than usual GP care alone. No cost-effective advantage of the commercially developed cCBT programme was evident compared with the free-to-use cCBT programme. Current UK practice recommendations for cCBT may need to be reconsidered in the light of the results.

AB - BACKGROUND: Computerized cognitive-behavioural therapy (cCBT) forms a core component of stepped psychological care for depression. Existing evidence for cCBT has been informed by developer-led trials. This is the first study based on a large independent pragmatic trial to assess the cost-effectiveness of cCBT as an adjunct to usual general practitioner (GP) care compared with usual GP care alone and to establish the differential cost-effectiveness of a free-to-use cCBT programme (MoodGYM) in comparison with a commercial programme (Beating the Blues) in primary care.METHOD: Costs were estimated from a healthcare perspective and outcomes measured using quality-adjusted life years (QALYs) over 2 years. The incremental cost-effectiveness of each cCBT programme was compared with usual GP care. Uncertainty was estimated using probabilistic sensitivity analysis and scenario analyses were performed to assess the robustness of results.RESULTS: Neither cCBT programme was found to be cost-effective compared with usual GP care alone. At a £20 000 per QALY threshold, usual GP care alone had the highest probability of being cost-effective (0.55) followed by MoodGYM (0.42) and Beating the Blues (0.04). Usual GP care alone was also the cost-effective intervention in the majority of scenario analyses. However, the magnitude of the differences in costs and QALYs between all groups appeared minor (and non-significant).CONCLUSIONS: Technically supported cCBT programmes do not appear any more cost-effective than usual GP care alone. No cost-effective advantage of the commercially developed cCBT programme was evident compared with the free-to-use cCBT programme. Current UK practice recommendations for cCBT may need to be reconsidered in the light of the results.

KW - Computerized cognitive–behavioural therapy

KW - depression

KW - primary care

KW - Quality-Adjusted Life Years

KW - Humans

KW - Middle Aged

KW - England

KW - Cognitive Behavioral Therapy/economics

KW - Male

KW - Therapy, Computer-Assisted/economics

KW - Depression/drug therapy

KW - Primary Health Care/economics

KW - Cost-Benefit Analysis

KW - Adult

KW - Female

KW - Depressive Disorder/drug therapy

KW - Outcome Assessment (Health Care)/economics

UR - https://www.cambridge.org/core/journals/psychological-medicine/article/div-classtitlecost-effectiveness-of-computerized-cognitivebehavioural-therapy-for-the-treatment-of-depression-in-primary-care-findings-from-the-randomised-evaluation-of-the-effectiveness-and-acceptability-of-computerised-therapy-reeact-trialdiv/89434A14B05D25768D3DEE4513734A53

UR - http://www.scopus.com/inward/record.url?scp=85013469076&partnerID=8YFLogxK

U2 - 10.1017/S0033291717000289

DO - 10.1017/S0033291717000289

M3 - Article

C2 - 28228182

SN - 0033-2917

VL - 47

SP - 1825

EP - 1835

JO - Psychological Medicine

JF - Psychological Medicine

IS - 10

ER -