The cost-effectiveness of different formats for delivery of cognitive behavioural therapy for depression: a systematic review based economic model

Qi Wu; Jinshuo Li; Steve Parrott; Jose A Lopez-Lopez; Sarah R Davies; Deborah M Caldwell; Rachel Churchill; TJ Peters; Glyn Lewis; Debbie Tallon; Sarah Dawson; Abigail Taylor; David S Kessler; Nicola J Wiles; Nicky J Welton

doi:10.1016/j.jval.2020.07.008

The cost-effectiveness of different formats for delivery of cognitive behavioural therapy for depression: a systematic review based economic model

Qi Wu^*, Jinshuo Li, Steve Parrott, Jose A Lopez-Lopez, Sarah R Davies, Deborah M Caldwell, Rachel Churchill, TJ Peters, Glyn Lewis, Debbie Tallon, Sarah Dawson, Abigail Taylor, David S Kessler, Nicola J Wiles, Nicky J Welton

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

6 Citations (Scopus)

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Abstract

Objectives
Cognitive behavioural therapy (CBT) is an effective treatment for depression. Different CBT delivery formats (face-to-face (F2F), multimedia (MM) and hybrid) and intensities have been used to expand access to the treatment. The aim of this study is to estimate the long-term cost-effectiveness of different CBT delivery modes.

Methods
A decision-analytic model was developed to evaluate the cost-effectiveness of different CBT delivery modes and variations in intensity in comparison with treatment-as-usual (TAU). The model covered an average treatment period of four-month with a 5-year follow-up period. The model was populated using a systematic review of randomised controlled trials and various sources from the literature.

Results
Incremental cost-effectiveness ratios (ICERs) of treatments compared with the next best option after excluding all the dominated and extended dominated options are: £209/QALY for 6(sessions)×30(minutes) F2F-CBT vs TAU; £4,453/QALY for 8×30 F2F vs 6×30 F2F, £12,216/QALY for 8×60 F2F vs 8×30 F2F; £43,072/QALY for 16x60 F2F vs 8×60 F2F. 8×30 F2F-CBT has the highest net monetary benefit for thresholds of £20,000-£30,000/QALY. Probabilistic sensitivity analysis illustrated 6×30 F2F-CBT had the highest probability (32.8%) of being cost-effective at £20,000/QALY, 16×60 F2F-CBT had the highest probability (31.0%) at £30,000/QALY.

Conclusions
All CBT delivery modes on top of TAU were found to be more cost-effective than TAU alone. Four F2F-CBT options (6×30, 8×30, 8×60, 16×60) are on the cost-effectiveness frontier. F2F-CBT with intensities of 6×30 and 16×60 had the highest probabilities of being cost-effective. However, the results should be interpreted with caution due to the high level of uncertainty.

Original language	English
Pages (from-to)	1662-1670
Number of pages	9
Journal	Value in Health
Volume	23
Issue number	12
DOIs	https://doi.org/10.1016/j.jval.2020.07.008
Publication status	Published - 24 Sept 2020

Research Groups and Themes

BRTC
HEHP@Bristol

Keywords

cognitive behavioral therapy
cost-effectiveness
decision-analytic model
depression

Access to Document

10.1016/j.jval.2020.07.008

Full-text PDF (author accepted manuscript)
This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Elsevier at https://doi.org/10.1016/j.jval.2020.07.008 . Please refer to any applicable terms of use of the publisher.
Accepted author manuscript, 806 KBLicence: CC BY-NC-ND

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Persistent link

PGfAR: Stage2 BRTC Integrated therapist and online CBT for depression in primary care ("INTERACT")
Wiles, N. J. (Principal Investigator)
1/04/16 → 31/03/22
Project: Research, Parent

Cite this

Wu, Q., Li, J., Parrott, S., Lopez-Lopez, J. A., Davies, S. R., Caldwell, D. M., Churchill, R., Peters, TJ., Lewis, G., Tallon, D., Dawson, S., Taylor, A., Kessler, D. S., Wiles, N. J., & Welton, N. J. (2020). The cost-effectiveness of different formats for delivery of cognitive behavioural therapy for depression: a systematic review based economic model. Value in Health, 23(12), 1662-1670. https://doi.org/10.1016/j.jval.2020.07.008

@article{37ab86089d9a429a8b77f0106eddf04d,

title = "The cost-effectiveness of different formats for delivery of cognitive behavioural therapy for depression: a systematic review based economic model",

abstract = "ObjectivesCognitive behavioural therapy (CBT) is an effective treatment for depression. Different CBT delivery formats (face-to-face (F2F), multimedia (MM) and hybrid) and intensities have been used to expand access to the treatment. The aim of this study is to estimate the long-term cost-effectiveness of different CBT delivery modes. MethodsA decision-analytic model was developed to evaluate the cost-effectiveness of different CBT delivery modes and variations in intensity in comparison with treatment-as-usual (TAU). The model covered an average treatment period of four-month with a 5-year follow-up period. The model was populated using a systematic review of randomised controlled trials and various sources from the literature. Results Incremental cost-effectiveness ratios (ICERs) of treatments compared with the next best option after excluding all the dominated and extended dominated options are: £209/QALY for 6(sessions)×30(minutes) F2F-CBT vs TAU; £4,453/QALY for 8×30 F2F vs 6×30 F2F, £12,216/QALY for 8×60 F2F vs 8×30 F2F; £43,072/QALY for 16x60 F2F vs 8×60 F2F. 8×30 F2F-CBT has the highest net monetary benefit for thresholds of £20,000-£30,000/QALY. Probabilistic sensitivity analysis illustrated 6×30 F2F-CBT had the highest probability (32.8%) of being cost-effective at £20,000/QALY, 16×60 F2F-CBT had the highest probability (31.0%) at £30,000/QALY. Conclusions All CBT delivery modes on top of TAU were found to be more cost-effective than TAU alone. Four F2F-CBT options (6×30, 8×30, 8×60, 16×60) are on the cost-effectiveness frontier. F2F-CBT with intensities of 6×30 and 16×60 had the highest probabilities of being cost-effective. However, the results should be interpreted with caution due to the high level of uncertainty.",

keywords = "cognitive behavioral therapy, cost-effectiveness, decision-analytic model, depression",

author = "Qi Wu and Jinshuo Li and Steve Parrott and Lopez-Lopez, {Jose A} and Davies, {Sarah R} and Caldwell, {Deborah M} and Rachel Churchill and TJ Peters and Glyn Lewis and Debbie Tallon and Sarah Dawson and Abigail Taylor and Kessler, {David S} and Wiles, {Nicola J} and Welton, {Nicky J}",

year = "2020",

month = sep,

day = "24",

doi = "10.1016/j.jval.2020.07.008",

language = "English",

volume = "23",

pages = "1662--1670",

journal = "Value in Health",

issn = "1098-3015",

publisher = "Elsevier Inc.",

number = "12",

}

Wu, Q, Li, J, Parrott, S, Lopez-Lopez, JA , Davies, SR , Caldwell, DM, Churchill, R, Peters, TJ, Lewis, G, Tallon, D , Dawson, S, Taylor, A, Kessler, DS , Wiles, NJ & Welton, NJ 2020, 'The cost-effectiveness of different formats for delivery of cognitive behavioural therapy for depression: a systematic review based economic model', Value in Health, vol. 23, no. 12, pp. 1662-1670. https://doi.org/10.1016/j.jval.2020.07.008

TY - JOUR

T1 - The cost-effectiveness of different formats for delivery of cognitive behavioural therapy for depression

T2 - a systematic review based economic model

AU - Wu, Qi

AU - Li, Jinshuo

AU - Parrott, Steve

AU - Lopez-Lopez, Jose A

AU - Davies, Sarah R

AU - Caldwell, Deborah M

AU - Churchill, Rachel

AU - Peters, TJ

AU - Lewis, Glyn

AU - Tallon, Debbie

AU - Dawson, Sarah

AU - Taylor, Abigail

AU - Kessler, David S

AU - Wiles, Nicola J

AU - Welton, Nicky J

PY - 2020/9/24

Y1 - 2020/9/24

N2 - ObjectivesCognitive behavioural therapy (CBT) is an effective treatment for depression. Different CBT delivery formats (face-to-face (F2F), multimedia (MM) and hybrid) and intensities have been used to expand access to the treatment. The aim of this study is to estimate the long-term cost-effectiveness of different CBT delivery modes. MethodsA decision-analytic model was developed to evaluate the cost-effectiveness of different CBT delivery modes and variations in intensity in comparison with treatment-as-usual (TAU). The model covered an average treatment period of four-month with a 5-year follow-up period. The model was populated using a systematic review of randomised controlled trials and various sources from the literature. Results Incremental cost-effectiveness ratios (ICERs) of treatments compared with the next best option after excluding all the dominated and extended dominated options are: £209/QALY for 6(sessions)×30(minutes) F2F-CBT vs TAU; £4,453/QALY for 8×30 F2F vs 6×30 F2F, £12,216/QALY for 8×60 F2F vs 8×30 F2F; £43,072/QALY for 16x60 F2F vs 8×60 F2F. 8×30 F2F-CBT has the highest net monetary benefit for thresholds of £20,000-£30,000/QALY. Probabilistic sensitivity analysis illustrated 6×30 F2F-CBT had the highest probability (32.8%) of being cost-effective at £20,000/QALY, 16×60 F2F-CBT had the highest probability (31.0%) at £30,000/QALY. Conclusions All CBT delivery modes on top of TAU were found to be more cost-effective than TAU alone. Four F2F-CBT options (6×30, 8×30, 8×60, 16×60) are on the cost-effectiveness frontier. F2F-CBT with intensities of 6×30 and 16×60 had the highest probabilities of being cost-effective. However, the results should be interpreted with caution due to the high level of uncertainty.

AB - ObjectivesCognitive behavioural therapy (CBT) is an effective treatment for depression. Different CBT delivery formats (face-to-face (F2F), multimedia (MM) and hybrid) and intensities have been used to expand access to the treatment. The aim of this study is to estimate the long-term cost-effectiveness of different CBT delivery modes. MethodsA decision-analytic model was developed to evaluate the cost-effectiveness of different CBT delivery modes and variations in intensity in comparison with treatment-as-usual (TAU). The model covered an average treatment period of four-month with a 5-year follow-up period. The model was populated using a systematic review of randomised controlled trials and various sources from the literature. Results Incremental cost-effectiveness ratios (ICERs) of treatments compared with the next best option after excluding all the dominated and extended dominated options are: £209/QALY for 6(sessions)×30(minutes) F2F-CBT vs TAU; £4,453/QALY for 8×30 F2F vs 6×30 F2F, £12,216/QALY for 8×60 F2F vs 8×30 F2F; £43,072/QALY for 16x60 F2F vs 8×60 F2F. 8×30 F2F-CBT has the highest net monetary benefit for thresholds of £20,000-£30,000/QALY. Probabilistic sensitivity analysis illustrated 6×30 F2F-CBT had the highest probability (32.8%) of being cost-effective at £20,000/QALY, 16×60 F2F-CBT had the highest probability (31.0%) at £30,000/QALY. Conclusions All CBT delivery modes on top of TAU were found to be more cost-effective than TAU alone. Four F2F-CBT options (6×30, 8×30, 8×60, 16×60) are on the cost-effectiveness frontier. F2F-CBT with intensities of 6×30 and 16×60 had the highest probabilities of being cost-effective. However, the results should be interpreted with caution due to the high level of uncertainty.

KW - cognitive behavioral therapy

KW - cost-effectiveness

KW - decision-analytic model

KW - depression

U2 - 10.1016/j.jval.2020.07.008

DO - 10.1016/j.jval.2020.07.008

M3 - Article (Academic Journal)

C2 - 33248522

SN - 1098-3015

VL - 23

SP - 1662

EP - 1670

JO - Value in Health

JF - Value in Health

IS - 12

ER -

The cost-effectiveness of different formats for delivery of cognitive behavioural therapy for depression: a systematic review based economic model

Abstract

Research Groups and Themes

Keywords

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Projects

PGfAR: Stage2 BRTC Integrated therapist and online CBT for depression in primary care ("INTERACT")

Cite this