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The British Journal of Psychiatry (2004) 185: 55-62
© 2004 The Royal College of Psychiatrists

Cost-effectiveness of computerised cognitive–behavioural therapy for anxiety and depression in primary care: randomised controlled trial

Paul McCrone, PhD

Institute of Psychiatry, King’s College London

Martin Knapp, PhD

Institute of Psychiatry, King’s College London, and Personal Social Services Research Unit, London School of Economics, London

Judith Proudfoot, PhD

University of New South Wales, Sydney, Australia

Clash Ryden, BSc

Institute of Psychiatry, King’s College London

Kate Cavanagh, DPhil

Ultrasis UK Ltd, London

David A. Shapiro, PhD

Universities of Leeds and Sheffield

Sophie Ilson, MBBS, Jeffrey A. Gray, PhD, David Goldberg, MD FRCPsych and Anthony Mann, MD FRCPsych

Institute of Psychiatry, King’s College London

Isaac Marks, MD FRCPsych

Imperial College, London

Brian Everitt, MSc and Andre Tylee, MD FRCPsych

Institute of Psychiatry, King’s College London, UK

Correspondence: Dr Paul McCrone, Centre for the Economics of Mental Health, Box PO24, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel: +44(0)20 7848 0198

Declaration of interest J.P. and J.A.G. are minority partners in the commercial exploitation of Beating the Blues, the computerised therapy program used in the study, and D.G. and D.A.S. are occasional consultants to Ultrasis plc; K.C. works for Ultrasis plc.

See pp. 46–54, this issue.

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.

Aims To assess the cost-effectiveness of computer-delivered CBT.

Method 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 (90% CI – £28 to £148) higher over 8 months for computer-delivered CBT. Lost-employment costs were £407 (90% CI £196 to £586) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at £40, 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.

Related articles in BJP:

Highlights of this issue

BJP 2004 185: 1-a3. [Full Text]  

Clinical efficacy of computerised cognitive–behavioural therapy for anxiety and depression in primary care: randomised controlled trial

Judith Proudfoot, Clash Ryden, Brian Everitt, David A. Shapiro, David Goldberg, Anthony Mann, Andre Tylee, Isaac Marks, and Jeffrey A. Gray
BJP 2004 185: 46-54. [Abstract] [Full Text]  

Peter Tyrer
BJP 2004 185: 92. [Full Text]  

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