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

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.