Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial†

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Abstract

Background

Cognitive-behavioural therapy (CBT) is effective for treating anxiety and depression in primary care, but there is a shortage of therapists. Computer-delivered treatment may be a viable alternative.

Aims

To assess the cost-effectiveness of computer-delivered CBT.

Method

A sample of people with depression or anxiety were randomised to usual care (n=128) or computer-delivered CBT (n=146). Costs were available for 123 and 138 participants, respectively. Costs and depression scores were combined using the net benefit approach.

Results

Service costs were £40 (90% CI −£28 to £148) higher over 8 months for computer-delivered CBT. Lost-employment costs were £407 (90% CI £196 to £586) less for this group. Valuing a I-unit improvement on the Beck Depression Inventory at £40, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year.

Conclusions

Computer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.

Declaration of interest

J.P. and J.A.G. are minority partners in the commercial exploitation of Beating the Blues, the computerised therapy program used in the study, and D.G. and D.A.S. are occasional consultants to Ultrasis plc; K.C. works for Ultrasis plc.

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