Cost-Effectiveness of Different Formats for Delivery of Cognitive Behavioral Therapy for Depression: A Systematic Review Based Economic

Objectives: Cognitive behavioral therapy (CBT) is an effective treatment for depression. Different CBT delivery formats (faceto-face [F2F], multimedia, and hybrid) and intensities have been used to expand access to the treatment. The aim of this study is to estimate the long-term cost-effectiveness of different CBT delivery modes. Methods: A decision-analytic model was developed to evaluate the cost-effectiveness of different CBT delivery modes and variations in intensity in comparison with treatment as usual (TAU). The model covered an average treatment period of 4 months with a 5-year follow-up period. The model was populated using a systematic review of randomized controlled trials and various sources from the literature. Results: Incremental cost-effectiveness ratios of treatments compared with the next best option after excluding all the dominated and extended dominated options are: 209/quality-adjusted life year (QALY) for 6 (sessions) x 30 (minutes) F2F-CBT versus TAU; 4 pound 453/QALY for 8 x 30 F2F versus 6 x 30 F2F; 12 pound 216/QALY for 8 x 60 F2F versus 8 x 30 F2F; and 43 pound 072/QALY for 16 x 60 F2F versus 8 x 60 F2F. The treatment with the highest net monetary benefit for thresholds of 20 pound 000 to 30 pound 000/QALY was 8 x 30 F2F-CBT. Probabilistic sensitivity analysis illustrated 6 x 30 F2F-CBT had the highest probability (32.8%) of being cost-effective at 20 pound 000/QALY; 16 x 60 F2F-CBT had the highest probability (31.0%) at 30 pound 000/QALY. Conclusions: All CBT delivery modes on top of TAU were found to be more cost-effective than TAU alone. Four F2F-CBT options (6 x 30, 8 x 30, 8 x 60,16 x 60) are on the cost-effectiveness frontier. F2F-CBT with intensities of 6 x 30 and 16 x 60 had the highest probabilities of being cost-effective. The results, however, should be interpreted with caution owing to the high level of uncertainty.