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

• Published in: British journal of psychiatry 2004-07, Vol.185 (1), p.55-62
• Main Authors: McCrone, Paul, Knapp, Martin, Proudfoot, Judith, Ryden, Clash, Cavanagh, Kate, Shapiro, David A., Ilson, Sophie, Gray, Jeffrey A., Goldberg, David, Mann, Anthony, Marks, Isaac, Everitt, Brian, Tylee, Andre
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anxiety; Anxiety - economics; Anxiety - therapy; Anxiety Disorders - economics; Anxiety Disorders - therapy; Behavior modification; Clinical outcomes; Cognitive ability; Cognitive behavioral therapy; Cognitive Behavioral Therapy - economics; Cognitive Behavioral Therapy - methods; Cognitive behaviour therapy; Cognitive therapy; Cognitive-behavioral factors; Computer-Assisted Instruction - economics; Computerization; Cost analysis; Cost effectiveness; Cost of Illness; Cost-Benefit Analysis; Counseling; Depression; Depression - economics; Depression - therapy; Employment; Female; Health Care Costs; Humans; Intervention; Male; Mental depression; Mental health; Middle Aged; Nurses; Primary care; Primary health care; Primary Health Care - economics; Primary Health Care - methods; Psychiatry; Therapists; Therapy; Treatment Outcome
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.185.1.55

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. To assess the cost-effectiveness of computer-delivered CBT. 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. Service costs were 40 British pounds (90% CI - 28 British pounds to 148 British pounds) higher over 8 months for computer-delivered CBT. Lost-employment costs were 407 British pounds (90% CI 196 British pounds to 586 British pounds) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at 40 British pounds, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year. Computer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.