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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

Published online by Cambridge University Press:  23 February 2017

A. Duarte ,
S. Walker ,
E. Littlewood ,
S. Brabyn ,
C. Hewitt ,
S. Gilbody  and
S. Palmer
A. Duarte*
Affiliation:
Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK
S. Walker
Affiliation:
Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK
E. Littlewood
Affiliation:
Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
S. Brabyn
Affiliation:
Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
C. Hewitt
Affiliation:
Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
S. Gilbody
Affiliation:
Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
S. Palmer
Affiliation:
Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK
*
*Address for correspondence: A. Duarte, Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK. (Email: ana.duarte@york.ac.uk)
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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.

Keywords

Computerized cognitive–behavioural therapydepressionprimary care
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 10 , July 2017 , pp. 1825 - 1835
Copyright
Copyright © Cambridge University Press 2017 

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