The cost effectiveness of CBT for depression in Primary Care

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The January 2014 edition of the British Journal of Psychiatry [(2014) 204, 69-76] contained a paper entitled:


“Cost effectiveness of cognitive –behaviour therapy for treatment resistant depression in primary care: economic evaluation of the CoBaIT Trial.”



Sandra Hollingworth et al (2014) implemented a randomised control trial of usual care versus usual care plus CBT to patients who suffered from treatment resistant depression.


The Star*D study in the USA showed approximately a third of depressed people do not respond to antidepressant treatment alone.


CBT can be delivered face to face, in a group setting, by computerised packages or now with a mobile app. Numerous studies demonstrate it is effective in treating previously untreated depression and treatment resistant depression.


The researchers recruited UK based primary care patients, aged between 18 and 75 years, who had adhered to antidepressant medication for at least 6 weeks, but who continued to suffer significant depressive symptoms as indicated by the Beck Depression Inventory, BDI-II, (score>14).


Patients in the active treatment group were randomised to receive 12 to 18 one hour-long sessions at their GP’s surgery. Eleven therapists working across 3 sites used the same CBT manual.The control group received unrestricted usual care from their GP. All patients were taking antidepressants at the time of randomisation.


The primary outcome for the trial was a reduction in BDI –II score of at least 50% at 6mths compared to the baseline score. A range of other outcomes were recorded at 12 mths to determine the sustainability of the effect. ( BDI –II, remission BDI-II,10, SF-12 and ED-5D-3L)


A total of 469 patients were recruited; 234 to CBT plus usual care and 235 to usual care alone. 73% were women, the average age being 49.6 years.


The mean baseline score on BDI-II was 31.8 ( 29 and above is interpreted as severe). Seventy per cent had been on antidepressants for more than 12 mths.

Over 90% had at least one prescription for antidepressants and 10% had more than 15.


Use of hospital services was low, 4% attended A&E, 6% attended an out patient clinic and only 1% had an in patient over night admission. 22% had some time off work because of their illness, the mean duration being 54 days.


The mean cost per patient in the CBT group was £766 and the usual care group cost £786 per patient. The increased costs were mainly due to more GP visits and more medication expenses (both pharmacological and complementary).


All three outcome measures were better in the CBT group, at 12 months the mean score was 5.1 points lower and twice as many in the CBT group recorded a 50% reduction on BDI-II.


Thus CBT is a cost effective adjunct to usual care for the treatment of treatment resistant depression in a primary care setting.


The cost of the face- to- face CBT provided was  £910. The cost effectiveness of mobile CBT, which can be provided at a much less cost would be far more.sad

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This article was written by Cloud Psychology