Sandra Hollinghurst1, Fran E Carroll, Anna Abel, John Campbell, Anne Garland, Bill Jerrom, David Kessler, Willem Kuyken, Jill Morrison, Nicola Ridgway, Laura Thomas, Katrina Turner, Chris Williams, Tim J Peters, Glyn Lewis, Nicola Wiles. 1. Sandra Hollinghurst, BA, MA, PhD, Fran E. Carroll, BSc, MSc, PhD, School of Social and Community Medicine, University of Bristol, Bristol; Anna Abel, BSc, Mphil; John Campbell, MD, FRCGP, University of Exeter Medical School, Exeter; Anne Garland, MSc, Nottingham Psychotherapy Unit, Nottinghamshire Healthcare NHS Trust, Nottingham; Bill Jerrom, PhD, Avon and Wiltshire Mental Health Partnership NHS Trust, Chippenham; David Kessler, MD, School of Social and Community Medicine, University of Bristol, Bristol; Willem Kuyken, BSc, PhD, DclinPsy, School of Psychology, University of Exeter, Exeter; Jill Morrison, MBChB, MSc, PhD, Academic Unit of General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Nicola Ridgway, MA, PgDip, PhD, Academic Unit of Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow; Laura Thomas, BA, MPhil, Katrina Turner, BSc, MSc, PhD, School of Social and Community Medicine, University of Bristol, Bristol; Chris Williams, MBChB, BSc, MmedSc, MD, Academic Unit of Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow; Tim J. Peters, BSc, MSc, PhD, School of Clinical Sciences, University of Bristol, Bristol; Glyn Lewis, PhD, FRCPsych, Nicola Wiles, BSc, PhD, School of Social and Community Medicine, University of Bristol, Bristol, UK.
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.
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.
Authors: M C Barnes; J L Donovan; C Wilson; J Chatwin; R Davies; J Potokar; N Kapur; K Hawton; R O'Connor; D Gunnell Journal: BMC Psychiatry Date: 2017-03-03 Impact factor: 3.630
Authors: Nicola Wiles; Abigail Taylor; Nicholas Turner; Maria Barnes; John Campbell; Glyn Lewis; Jill Morrison; Tim J Peters; Laura Thomas; Katrina Turner; David Kessler Journal: Br J Gen Pract Date: 2018-10 Impact factor: 5.386