title: Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial.
abstract: BACKGROUND
  Cognitive-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.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of computer-delivered CBT.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Service costs were 40 British pounds (90% CI - 28 British pounds to 148 British pounds) higher over 8 months for computer-delivered CBT. Lost-employment costs were 407 British pounds (90% CI 196 British pounds to 586 British pounds) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at 40 British pounds, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year.
  
  
  CONCLUSIONS
  Computer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.
authors.affiliation: Centre for the Economics of Mental Health, Institute of Psychiatry, King's College London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Judith
authors.initials: J
authors.lastname: Proudfoot
authors.forename: Clash
authors.initials: C
authors.lastname: Ryden
authors.forename: Kate
authors.initials: K
authors.lastname: Cavanagh
authors.forename: David A
authors.initials: DA
authors.lastname: Shapiro
authors.forename: Sophie
authors.initials: S
authors.lastname: Ilson
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gray
authors.forename: David
authors.initials: D
authors.lastname: Goldberg
authors.forename: Anthony
authors.initials: A
authors.lastname: Mann
authors.forename: Isaac
authors.initials: I
authors.lastname: Marks
authors.forename: Brian
authors.initials: B
authors.lastname: Everitt
authors.forename: Andre
authors.initials: A
authors.lastname: Tylee
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000191:economics / Q000628:therapy*; D001008:Anxiety Disorders / Q000191:economics / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods; D003194:Computer-Assisted Instruction / Q000191:economics*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003863:Depression / Q000191:economics / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome