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Cost-effectiveness of cognitive–behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: economic evaluation of the CoBalT Trial

  • Sandra Hollinghurst (a1), Fran E. Carroll (a1), Anna Abel (a2), John Campbell (a2), Anne Garland (a3), Bill Jerrom (a4), David Kessler (a1), Willem Kuyken (a5), Jill Morrison (a6), Nicola Ridgway (a7), Laura Thomas (a1), Katrina Turner (a1), Chris Williams (a7), Tim J. Peters (a8), Glyn Lewis (a9) and Nicola Wiles (a9)...

Abstract

Background

Depression is expensive to treat, but providing ineffective treatment is more expensive. Such is the case for many patients who do not respond to antidepressant medication.

Aims

To assess the cost-effectiveness of cognitive–behavioural therapy (CBT) plus usual care for primary care patients with treatment-resistant depression compared with usual care alone.

Method

Economic evaluation at 12 months alongside a randomised controlled trial. Cost-effectiveness assessed using a cost-consequences framework comparing cost to the health and social care provider, patients and society, with a range of outcomes. Cost-utility analysis comparing health and social care costs with quality-adjusted life-years (QALYs).

Results

The mean cost of CBT per participant was £910. The difference in QALY gain between the groups was 0.057, equivalent to 21 days a year of good health. The incremental cost-effectiveness ratio was £14 911 (representing a 74% probability of the intervention being cost-effective at the National Institute of Health and Care Excellence threshold of £20 000 per QALY). Loss of earnings and productivity costs were substantial but there was no evidence of a difference between intervention and control groups.

Conclusions

The addition of CBT to usual care is cost-effective in patients who have not responded to antidepressants. Primary care physicians should therefore be encouraged to refer such individuals for CBT.

Copyright

Corresponding author

Sandra Hollinghurst, BA, MA, PhD, Department of Social and Community Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PS, UK. Email s.p.hollinghurst@bristol.ac.uk

Footnotes

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This research was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number: 06/404/02).

Declaration of interest

C.W. and A.G. are CBT workshop leaders. W.K. teaches nationally and internationally on CBT.

Footnotes

References

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Cost-effectiveness of cognitive–behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: economic evaluation of the CoBalT Trial

  • Sandra Hollinghurst (a1), Fran E. Carroll (a1), Anna Abel (a2), John Campbell (a2), Anne Garland (a3), Bill Jerrom (a4), David Kessler (a1), Willem Kuyken (a5), Jill Morrison (a6), Nicola Ridgway (a7), Laura Thomas (a1), Katrina Turner (a1), Chris Williams (a7), Tim J. Peters (a8), Glyn Lewis (a9) and Nicola Wiles (a9)...
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