title: Cost-effectiveness of computerized cognitive-behavioural therapy for the treatment of depression in primary care: findings from the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial.
abstract: BACKGROUND
  Computerized cognitive-behavioural therapy (cCBT) forms a core component of stepped psychological care for depression. Existing evidence for cCBT has been informed by developer-led trials. This is the first study based on a large independent pragmatic trial to assess the cost-effectiveness of cCBT as an adjunct to usual general practitioner (GP) care compared with usual GP care alone and to establish the differential cost-effectiveness of a free-to-use cCBT programme (MoodGYM) in comparison with a commercial programme (Beating the Blues) in primary care.
  
  
  METHODS
  Costs were estimated from a healthcare perspective and outcomes measured using quality-adjusted life years (QALYs) over 2 years. The incremental cost-effectiveness of each cCBT programme was compared with usual GP care. Uncertainty was estimated using probabilistic sensitivity analysis and scenario analyses were performed to assess the robustness of results.
  
  
  RESULTS
  Neither cCBT programme was found to be cost-effective compared with usual GP care alone. At a £20 000 per QALY threshold, usual GP care alone had the highest probability of being cost-effective (0.55) followed by MoodGYM (0.42) and Beating the Blues (0.04). Usual GP care alone was also the cost-effective intervention in the majority of scenario analyses. However, the magnitude of the differences in costs and QALYs between all groups appeared minor (and non-significant).
  
  
  CONCLUSIONS
  Technically supported cCBT programmes do not appear any more cost-effective than usual GP care alone. No cost-effective advantage of the commercially developed cCBT programme was evident compared with the free-to-use cCBT programme. Current UK practice recommendations for cCBT may need to be reconsidered in the light of the results.
authors.affiliation: Centre for Health Economics, University of York,Heslington,York YO10 5DD,UK.
authors.forename: A
authors.initials: A
authors.lastname: Duarte
authors.affiliation: Centre for Health Economics, University of York,Heslington,York YO10 5DD,UK.
authors.forename: S
authors.initials: S
authors.lastname: Walker
authors.affiliation: Department of Health Sciences,University of York,Heslington,York YO10 5DD,UK.
authors.forename: E
authors.initials: E
authors.lastname: Littlewood
authors.affiliation: Department of Health Sciences,University of York,Heslington,York YO10 5DD,UK.
authors.forename: S
authors.initials: S
authors.lastname: Brabyn
authors.affiliation: Department of Health Sciences,University of York,Heslington,York YO10 5DD,UK.
authors.forename: C
authors.initials: C
authors.lastname: Hewitt
authors.affiliation: Department of Health Sciences,University of York,Heslington,York YO10 5DD,UK.
authors.forename: S
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: Centre for Health Economics, University of York,Heslington,York YO10 5DD,UK.
authors.forename: S
authors.initials: S
authors.lastname: Palmer
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics; D011320:Primary Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D013813:Therapy, Computer-Assisted / Q000191:economics*
keywords: Computerized cognitive–behavioural therapy; depression; primary care