title: Comparative effectiveness of cognitive therapies delivered face-to-face or over the telephone: an observational study using propensity methods.
abstract: OBJECTIVE
  To compare the clinical and cost-effectiveness of face-to-face (FTF) with over-the-telephone (OTT) delivery of low intensity cognitive behavioural therapy.
  
  
  METHODS
  Observational study following SROBE guidelines. Selection effects were controlled using propensity scores. Non-inferiority comparisons assessed effectiveness.
  
  
  METHODS
  IAPT (improving access to psychological therapies) services in the East of England.
  
  
  METHODS
  39,227 adults referred to IAPT services. Propensity score strata included 4,106 individuals; 147 pairs participated in 1:1 matching.
  
  
  METHODS
  Two or more sessions of computerised cognitive behavioural therapy (CBT).
  
  
  METHODS
  Patient-reported outcomes: Patient Health Questionnaire (PHQ-9) for depression; Generalised Anxiety Disorder questionnaire (GAD-7); Work and Social Adjustment Scale (WSAS). Differences between groups were summarised as standardised effect sizes (ES), adjusted mean differences and minimally important difference for PHQ-9. Cost per session for OTT was compared with FTF.
  
  
  RESULTS
  Analysis of covariance controlling for number of assessments, provider site, and baseline PHQ-9, GAD-7 and WSAS indicated statistically significantly greater reductions in scores for OTT treatment with moderate (PHQ-9: ES: 0.14; GAD-7: ES: 0.10) or small (WSAS: ES: 0.03) effect sizes. Non-inferiority in favour of OTT treatment for symptom severity persisted as small to moderate effects for all but individuals with the highest symptom severity. In the most stringent comparison, the one-to-one propensity matching, adjusted mean differences in treatment outcomes indicated non-inferiority between OTT versus FTF treatments for PHQ-9 and GAD-7, whereas the evidence was moderate for WSAS. The per-session cost for OTT was 36.2% lower than FTF.
  
  
  CONCLUSIONS
  The clinical effectiveness of low intensity CBT-based interventions delivered OTT was not inferior to those delivered FTF except for people with more severe illness where FTF was superior. This provides evidence for better targeting of therapy, efficiencies for patients, cost savings for services and greater access to psychological therapies for people with common mental disorders.
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care for Cambridgeshire and Peterborough, Cambridge, United Kingdom.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Hammond
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Croudace
authors.forename: Muralikrishnan
authors.initials: M
authors.lastname: Radhakrishnan
authors.forename: Louise
authors.initials: L
authors.lastname: Lafortune
authors.forename: Alison
authors.initials: A
authors.lastname: Watson
authors.forename: Fiona
authors.initials: F
authors.lastname: McMillan-Shields
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D057216:Propensity Score; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult