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BMJ mental health
Par Li J, Parrott S, MacNeill S et 18 autres.
Contenu en anglais
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We conducted a pragmatic, parallel two-group, multicentre randomised controlled trial to assess an online platform that integrates the use of online cognitive behavioural therapy (CBT) materials with therapist-led sessions via instant messaging and found it clinically effective, over and above usual care.
To investigate cost-effectiveness of integrated CBT over and above usual care over 12 months for primary care patients with depression.
We undertook incremental cost-utility analyses alongside the trial. The cost components in the primary analysis were integrated CBT and usual care, and wider healthcare and social services for mental health from a National Health Service (NHS) and personal social services (PSS) perspective. The secondary analyses included costs from other perspectives. The effect was measured by quality-adjusted life years (QALYs), derived from EuroQoL 5-Domain with 5-Level questionnaire. A series of sensitivity analyses was performed to assess uncertainties.
The mean costs of integrated CBT intervention were £987 (SE £14) per participant. The incremental cost-effectiveness ratio from an NHS/PSS perspective was £30 576 per QALY gained (probability of cost-effectiveness from £25 000 to £35 000/QALY: 26% to 50%). Secondary analyses also reported higher costs in the integrated CBT group from other perspectives.
Under National Institute for Health and Care Excellence thresholds, integrated CBT is cost-effective over and above usual care over 12 months with high decision uncertainty. Clinical implications: Although integrated CBT was found clinically effective, the economic evaluation alongside the trial did not find evidence with certainty to support its implementation over and above usual care. It should not be adopted as a standalone treatment option unless long-term cost-effectiveness is established.
Publié dans BMJ mental health. Le résumé est reproduit tel qu’il a été publié et reste l’œuvre de ses auteurs ; lisez l’article complet à la source.
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