scholarly journals Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial

2014 ◽  
Vol 18 (31) ◽  
Author(s):  
Nicola Wiles ◽  
Laura Thomas ◽  
Anna Abel ◽  
Maria Barnes ◽  
Fran Carroll ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Controlled Trial ◽  
Clinical Effectiveness ◽  
Behavioural Therapy ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Cognitive Behavioural ◽  
Resistant Depression ◽  
Randomised Controlled

A Randomized Controlled Trial of Cognitive Behavioural Therapy as an Adjunct to Pharmacotherapy in Primary Care Based Patients with Treatment Resistant Depression: A Pilot Study

2007 ◽  
Vol 36 (1) ◽  
pp. 21-33 ◽  
Author(s):  
Nicola J Wiles ◽  
Sandra Hollinghurst ◽  
Victoria Mason ◽  
Meyrem Musa ◽  
Victoria Burt ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Randomized Controlled ◽  
Cognitive Behavioural ◽  
Icd 10 ◽  
Resistant Depression

AbstractNo randomized controlled trials (RCTs) have been conducted of cognitive behavioural therapy (CBT) for depressed patients who have not responded to antidepressants, yet CBT is often reserved for this group. We conducted a pilot study for a pragmatic RCT of the clinical effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with treatment resistant depression (TRD). Patients on antidepressants for at least 6 weeks were mailed a study invitation by their GP. Those who consented to contact were mailed a questionnaire. TRD was defined as compliance with medication (self-report) and Beck Depression Inventory (BDI) ≥ 15. Those who met ICD-10 depression criteria were eligible for randomization and followed after 4 months. Of 440 patients mailed, 65% responded and 72% consented to contact. Ninety-four percent completed the questionnaire and 82 patients (42%) had TRD. Thirty were subsequently identified as ineligible and 10 did not participate further. Twenty-six of the remaining 42 patients met ICD-10 depression criteria and 25 agreed to being randomized. Twenty-three patients completed the 4-month follow-up questionnaire. Recruitment into a RCT to examine the effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with TRD appears feasible and should now be conducted.

scholarly journals A cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of a school-based cognitive–behavioural therapy programme (FRIENDS) in the reduction of anxiety and improvement in mood in children aged 9/10 years

2015 ◽  
Vol 3 (14) ◽  
pp. 1-88 ◽  
Author(s):  
Paul Stallard ◽  
Elena Skryabina ◽  
Gordon Taylor ◽  
Rob Anderson ◽  
Obioha C Ukoumunne ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Primary Schools ◽  
Controlled Trial ◽  
Clinical Effectiveness ◽  
Cluster Randomised Controlled Trial ◽  
Behavioural Therapy ◽  
Anxiety Prevention ◽  
Cognitive Behavioural ◽  
Prevention Programmes ◽  
Randomised Controlled

BackgroundAnxiety in children is common, impairs everyday functioning and increases the risk of severe mental health disorders in adulthood, yet few children with anxiety are identified and referred for treatment.ObjectiveTo investigate the clinical effectiveness and cost-effectiveness of a universal school-based preventative programme (FRIENDS) in reducing symptoms of anxiety and low mood.DesignCluster randomised controlled trial. Schools (n = 41) were randomly assigned after recruitment on a 1 : 1 : 1 basis to health-led FRIENDS, school-led FRIENDS and usual school provision.SettingPrimary schools in three local education authorities in the south-west of England.ParticipantsChildren (n = 1362) aged 9–10 years attending school and participating in personal, social and health education (PSHE).InterventionsThe FRIENDS programme is a cognitive–behavioural therapy programme that develops skills to counter the cognitive, emotional and behavioural aspects of anxiety. The FRIENDS programme was led by either a trained member of the school or a health leader external to the school and was delivered over 9 consecutive weeks. The comparison group received usual school PSHE lessons. Interventions were delivered in the academic year September 2011–July 2012.Main outcome measuresClinical effectiveness assessed by child report of symptoms of anxiety (Revised Child Anxiety and Depression Scale, RCADS); cost-effectiveness based on RCADS and quality-adjusted life-years (Child Health Utility 9 Dimensions, CHU-9D) between baseline and 6 months; process evaluation, evaluation of reach and attrition and qualitative feedback from children, school staff and parents.ResultsAt 12 months there was a difference in the adjusted mean RCADS scores for health-led FRIENDS compared with school-led FRIENDS [–3.91, 95% confidence interval (CI) –6.48 to –1.35] and for health-led FRIENDS compared with usual school provision (–2.66, 95% CI –5.22 to –0.09). At 24 months we were able to assess only 43.6% of our cohort. There were few differences in baseline characteristics between completers and non-completers. Child-reported anxiety in all three groups had reduced by 24 months and there were no longer any group effects. There were no between-group effects for any parent- or child-completed secondary outcomes at 12 or 24 months. The cost of the FRIENDS programme was £52–56 per child. We found no evidence that the FRIENDS programme was cost-effective over a 6-month period; however, our subgroup for the economic analysis differed significantly from our main trial cohort.ConclusionsAlthough greater reductions in anxiety were noted at 12 months when the FRIENDS programme was delivered by health leaders, these additional benefits were not maintained at 24 months. Children’s anxiety levels improved irrespective of the intervention that they received. Our economic evaluation and 24-month assessment had significant shortcomings. However, the universal delivery of specific anxiety prevention programmes will result in additional costs that may be beyond the finances available to most schools. Future work should identify the active ingredients and potential moderators of universal anxiety programmes to determine whether programme length can be reduced, short-term effectiveness maintained and cost-effectiveness improved. At present, our results find limited evidence to support the universal provision of specific anxiety prevention programmes in UK primary schools.Trial registrationCurrent Controlled Trials ISRCTN23563048.FundingThe National Institute for Health Research Public Health Research programme.

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

2014 ◽  
Vol 204 (1) ◽  
pp. 69-76 ◽  
Author(s):  
Sandra Hollinghurst ◽  
Fran E. Carroll ◽  
Anna Abel ◽  
John Campbell ◽  
Anne Garland ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Social Care ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Treatment Resistant ◽  
Cognitive Behavioural ◽  
Health And Social Care ◽  
Resistant Depression

BackgroundDepression 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.AimsTo 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.MethodEconomic 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).ResultsThe 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.ConclusionsThe 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.

Sign in / Sign up

Export Citation Format

Share Document