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

Hollinghurst, S. et al. (2014) Cost-effectiveness of cognitive-behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: economic evaluation of the CoBalT Trial. British Journal of Psychiatry, 204(1), pp. 69-76. (doi:10.1192/bjp.bp.112.125286)

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Abstract

<b>Background</b> 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.<p></p> <b>Aims</b> 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.<p></p> <b>Method</b> 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).<p></p> <b>Results</b> 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.<p></p> <b>Conclusions</b> 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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Williams, Professor Christopher and Ridgway, Dr Nicola and Morrison, Professor Jillian
Authors: Hollinghurst, S., Carroll, F.E., Abel, A., Campbell, J., Garland, A., Jerrom, B., Kessler, D., Kuyken, W., Morrison, J., Ridgway, N., Thomas, L., Turner, K., Williams, C., Peters, T.J., Lewis, G., and Wiles, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Journal Name:British Journal of Psychiatry
ISSN:0007-1250
ISSN (Online):1472-1465

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
459001Cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment resistant depression in primary care - a randomised controlled trial (COBALT)Christopher WilliamsHealth Technology Assessment (HTA)06/404/02IHW - MENTAL HEALTH & WELLBEING