Duarte, A orcid.org/0000-0002-0528-4773, Walker, S orcid.org/0000-0002-5750-3691, Littlewood, E orcid.org/0000-0002-4606-4590 et al. (4 more authors) (2017) 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. Psychological Medicine. pp. 1825-1835. ISSN 0033-2917
Abstract
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 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. |
Keywords: | Computerized cognitive–behavioural therapy,depression,primary care,Quality-Adjusted Life Years,Humans,Middle Aged,England,Cognitive Behavioral Therapy/economics,Male,Therapy, Computer-Assisted/economics,Depression/drug therapy,Primary Health Care/economics,Cost-Benefit Analysis,Adult,Female,Depressive Disorder/drug therapy,Outcome Assessment (Health Care)/economics |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Social Sciences (York) > Centre for Health Economics (York) The University of York > Faculty of Sciences (York) > Health Sciences (York) The University of York > Faculty of Sciences (York) > Hull York Medical School (York) The University of York > Faculty of Sciences (York) > Biology (York) |
Depositing User: | Pure (York) |
Date Deposited: | 28 Feb 2017 17:00 |
Last Modified: | 03 Mar 2025 00:04 |
Published Version: | https://doi.org/10.1017/S0033291717000289 |
Status: | Published |
Refereed: | Yes |
Identification Number: | 10.1017/S0033291717000289 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:112960 |