Pharmacotherapy and cognitive behavioural therapy: similarly cost effective compared with community referral for disadvantaged women with major depression

2006 ◽  
Vol 9 (1) ◽  
pp. 16-16
Author(s):  
M. K Byrne
Keyword(s):  
Major Depression ◽  
Cognitive Behavioural Therapy ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Disadvantaged Women ◽  
Cognitive Behavioural

scholarly journals Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive–behavioural therapy in adolescents with major depression

2007 ◽  
Vol 191 (6) ◽  
pp. 521-527 ◽  
Author(s):  
Sarah Byford ◽  
Barbara Barrett ◽  
Chris Roberts ◽  
Paul Wilkinson ◽  
Bernadka Dubicka ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Major Depression ◽  
Cognitive Behavioural Therapy ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Clinical Care ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Short Term ◽  
Cognitive Behavioural

BackgroundMajor depression is an important and costly problem among adolescents, yet evidence to support the provision of cost-effective treatments is lacking.AimsTo assess the short-term cost-effectiveness of combined selective serotonin reuptake inhibitors (SSRIs) and cognitive–behavioural therapy (CBT) together with clinical care compared with SSRIs and clinical care alone in adolescents with major depression.MethodPragmatic randomised controlled trial in the UK. Outcomes and costs were assessed at baseline, 12 and 28 weeks.ResultsThe trial comprised 208 adolescents, aged 11–17 years, with major or probable major depression who had not responded to a brief initial psychosocial intervention. There were no significant differences in outcome between the groups with and without CBT. Costs were higher in the group with CBT, although not significantly so (P=0.057). Cost-effectiveness analysis and exploration of the associated uncertainty suggest there is less than a 30% probability that CBT plus SSRIs is more cost-effective than SSRIs alone.ConclusionsA combination of CBT plus SSRIs is not more cost-effective in the short-term than SSRIs alone for treating adolescents with major depression in receipt of routine specialist clinical care.

scholarly journals Randomised controlled trial of cognitive behavioural therapy in COPD

2018 ◽  
Vol 4 (4) ◽  
pp. 00094-2018 ◽  
Author(s):  
Karen Heslop-Marshall ◽  
Christine Baker ◽  
Debbie Carrick-Sen ◽  
Julia Newton ◽  
Carlos Echevarria ◽  
...  
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Life Years ◽  
Cost Effective Treatment ◽  
Anxiety Subscale

Anxiety is an important comorbidity in chronic obstructive pulmonary disease (COPD). We investigated if cognitive behavioural therapy (CBT), delivered by respiratory nurses, reduced symptoms of anxiety and was cost-effective.Patients with COPD and anxiety were randomised to CBT or self-help leaflets. Anxiety, depression and quality of life were measured at baseline, 3, 6 and 12 months. A cost-effectiveness analysis was conducted from a National Health Service hospital perspective and quality-adjusted life-years estimated using the EuroQol-5D questionnaire.In total, 279 patients were recruited. Group mean change from baseline to 3 months in the Hospital Anxiety and Depression Anxiety Subscale was 3.4 (95% CI 2.62–4.17, p<0.001) for the CBT group and 1.88 (95% CI 1.19–2.55, p<0.001) in the leaflet group. The CBT group was superior to leaflets at 3 months (mean difference in the Hospital Anxiety and Depression Anxiety Subscale was 1.52, 95% CI 0.49–2.54, p=0.003). Importantly, the CBT intervention was more cost-effective than leaflets at 12 months, significantly lowering hospital admissions and attendance at emergency departments.CBT delivered by respiratory nurses is a clinically and cost-effective treatment for anxiety in patients with COPD relative to self-help leaflets.

scholarly journals Effectiveness of cognitive behavioural therapy augmentation in major depression treatment (ECAM study): study protocol for a randomised clinical trial

BMJ Open ◽  
2014 ◽  
Vol 4 (10) ◽  
pp. e006359 ◽  
Author(s):  
Atsuo Nakagawa ◽  
Mitsuhiro Sado ◽  
Dai Mitsuda ◽  
Daisuke Fujisawa ◽  
Toshiaki Kikuchi ◽  
...  
Keyword(s):  
Major Depression ◽  
Cognitive Behavioural Therapy ◽  
Study Protocol ◽  
Rating Scale ◽  
Behavioural Therapy ◽  
Depression Symptoms ◽  
Routine Practice ◽  
Depression Care ◽  
Treatment As Usual ◽  
Cognitive Behavioural

IntroductionMajor depression is a serious mental disorder that causes substantial distress and impairment in individuals and places an enormous burden on society. Although antidepressant treatment is the most common therapy provided in routine practice, there is little evidence to guide second-line therapy for patients who have failed to respond to antidepressants. The aim of this paper is to describe the study protocol for a randomised controlled trial that measures the clinical effectiveness of cognitive behavioural therapy (CBT) as an augmentation strategy to treat patients with non-psychotic major depression identified as suboptimal responders to usual depression care.Methods and analysisThe current study is a 16-week assessor-blinded randomised, parallel-groups superiority trial with 12-month follow-up at an outpatient clinic as part of usual depression care. Patients aged 20–65 years with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Major Depressive Disorder who have experienced at least one failed trial of antidepressants as part of usual depression care, will be randomly assigned to receive CBT plus treatment as usual, or treatment as usual alone. The primary outcome is the change in clinician-rated 17-item GRID-Hamilton Depression Rating Scale (GRID-HAMD) score at 16 weeks, and secondary outcomes include severity and change in scores of subjective depression symptoms, proportion of responders and remitters, safety and quality of life. The primary population will be the intention-to-treat patients.Ethics and disseminationAll protocols and the informed consent form comply with the Ethics Guideline for Clinical Research (Japanese Ministry of Health, Labour and Welfare). Ethics review committees at the Keio University School of Medicine and the Sakuragaoka Memorial Hospital approved the study protocol. The results of the study will be disseminated at several research conferences and as published articles in peer-reviewed journals. The study will be implemented and reported in line with the CONSORT statement.Trial registration numberUMIN Clinical Trials Registry: UMIN000001218.

scholarly journals 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

2017 ◽  
Vol 47 (10) ◽  
pp. 1825-1835 ◽  
Author(s):  
A. Duarte ◽  
S. Walker ◽  
E. Littlewood ◽  
S. Brabyn ◽  
C. Hewitt ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Scenario Analyses ◽  
Cognitive Behavioural ◽  
Life Years ◽  
Gp Care ◽  
The Cost

BackgroundComputerized 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.MethodCosts 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.ResultsNeither 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).ConclusionsTechnically 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.

scholarly journals Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial

2004 ◽  
Vol 185 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Paul McCrone ◽  
Martin Knapp ◽  
Judith Proudfoot ◽  
Clash Ryden ◽  
Kate Cavanagh ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Quality Adjusted Life Year ◽  
Anxiety And Depression ◽  
Net Benefit ◽  
Cognitive Behavioural

BackgroundCognitive-behavioural therapy (CBT) is effective for treating anxiety and depression in primary care, but there is a shortage of therapists. Computer-delivered treatment may be a viable alternative.AimsTo assess the cost-effectiveness of computer-delivered CBT.MethodA sample of people with depression or anxiety were randomised to usual care (n= 128) or computer-delivered CBT (n= 146). Costs were available for 123 and 138 participants, respectively. Costs and depression scores were combined using the net benefit approach.ResultsService costs were £40 (90% CI-£28 to £148) higher over 8 months for computer-delivered CBT. Lost-employment costs were £407 (90% CI £196 to £586) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at £40, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year.ConclusionsComputer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.

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