title: Cost-effectiveness of cognitive-behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: economic evaluation of the CoBalT Trial.
abstract: BACKGROUND
  Depression 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.
  
  
  OBJECTIVE
  To 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.
  
  
  METHODS
  Economic 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).
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Sandra Hollinghurst, BA, MA, PhD, Fran E. Carroll, BSc, MSc, PhD, School of Social and Community Medicine, University of Bristol, Bristol; Anna Abel, BSc, Mphil; John Campbell, MD, FRCGP, University of Exeter Medical School, Exeter; Anne Garland, MSc, Nottingham Psychotherapy Unit, Nottinghamshire Healthcare NHS Trust, Nottingham; Bill Jerrom, PhD, Avon and Wiltshire Mental Health Partnership NHS Trust, Chippenham; David Kessler, MD, School of Social and Community Medicine, University of Bristol, Bristol; Willem Kuyken, BSc, PhD, DclinPsy, School of Psychology, University of Exeter, Exeter; Jill Morrison, MBChB, MSc, PhD, Academic Unit of General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Nicola Ridgway, MA, PgDip, PhD, Academic Unit of Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow; Laura Thomas, BA, MPhil, Katrina Turner, BSc, MSc, PhD, School of Social and Community Medicine, University of Bristol, Bristol; Chris Williams, MBChB, BSc, MmedSc, MD, Academic Unit of Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow; Tim J. Peters, BSc, MSc, PhD, School of Clinical Sciences, University of Bristol, Bristol; Glyn Lewis, PhD, FRCPsych, Nicola Wiles, BSc, PhD, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Hollinghurst
authors.forename: Fran E
authors.initials: FE
authors.lastname: Carroll
authors.forename: Anna
authors.initials: A
authors.lastname: Abel
authors.forename: John
authors.initials: J
authors.lastname: Campbell
authors.forename: Anne
authors.initials: A
authors.lastname: Garland
authors.forename: Bill
authors.initials: B
authors.lastname: Jerrom
authors.forename: David
authors.initials: D
authors.lastname: Kessler
authors.forename: Willem
authors.initials: W
authors.lastname: Kuyken
authors.forename: Jill
authors.initials: J
authors.lastname: Morrison
authors.forename: Nicola
authors.initials: N
authors.lastname: Ridgway
authors.forename: Laura
authors.initials: L
authors.lastname: Thomas
authors.forename: Katrina
authors.initials: K
authors.lastname: Turner
authors.forename: Chris
authors.initials: C
authors.lastname: Williams
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Peters
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.forename: Nicola
authors.initials: N
authors.lastname: Wiles
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D003131:Combined Modality Therapy / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D061218:Depressive Disorder, Treatment-Resistant / Q000191:economics / Q000628:therapy*; D004739:England; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents