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Cost-effectiveness of internet-based cognitive-behavioural therapy and physical exercise for depression
Kraepelien M, Mattsson S, Hedman-Lagerlof E, Petersson IF, Forsell Y, Lindefors N, Kaldo V
BJPsych Open 2018 Jul;4(4):265-273
clinical trial
4/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Both internet-based cognitive-behavioural therapy (ICBT) and physical exercise are alternatives to treatment as usual (TAU) in managing mild to moderate depression in primary care. AIMS: To determine the cost-effectiveness of ICBT and physical exercise compared with TAU in primary care. METHOD: Economic evaluation of a randomised controlled trial (N = 945) in Sweden. Costs were estimated by a service use questionnaire and used together with the effects on quality-adjusted life-years (QALYs). The primary 3-month healthcare provider perspective in primary care was complemented by a 1-year societal perspective. RESULTS: The primary analysis showed that incremental cost per QALY gain was Euro 8,817 for ICBT and Euro 14,571 for physical exercise compared with TAU. At the established willingness-to-pay threshold of Euro 21,536 (GBP 20,000) per QALY, the probability of ICBT being cost-effective is 90%, and for physical exercise is 76%, compared with TAU. CONCLUSIONS: From a primary care perspective, both ICBT and physical exercise for depression are likely to be cost-effective compared with TAU. DECLARATION OF INTEREST: None.

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