Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. II: Cost effectiveness

National Primary Care Research and Development Centre (NPCRDC), University of Manchester, UK.
BMJ Clinical Research (Impact Factor: 14.09). 01/2001; 321(7273):1389-92. DOI: 10.1136/bmj.321.7273.1389
Source: PubMed

ABSTRACT To compare the cost effectiveness of general practitioner care and two general practice based psychological therapies for depressed patients.
Prospective, controlled trial with randomised and patient preference allocation arms.
General practices in London and greater Manchester.
464 of 627 patients presenting with depression or mixed anxiety and depression were suitable for inclusion.
Usual general practitioner care or up to 12 sessions of non-directive counselling or cognitive-behaviour therapy provided by therapists.
Beck depression inventory scores, EuroQol measure of health related quality of life, direct treatment and non-treatment costs, and cost of lost production.
197 patients were randomly assigned to treatment, 137 chose their treatment, and 130 were randomised only between the two psychological therapies. At four months, both non-directive counselling and cognitive-behaviour therapy reduced depressive symptoms to a significantly greater extent than usual general practitioner care. There was no significant difference in outcome between treatments at 12 months. There were no significant differences in direct costs, production losses, or societal costs between the three treatments at either four or 12 months. Sensitivity analyses did not suggest that the results depended on particular assumptions in the statistical analysis.
Within the constraints of available power, the data suggest that both brief psychological therapies may be significantly more cost effective than usual care in the short term, as benefit was gained with no significant difference in cost. There are no significant differences between treatments in either outcomes or costs at 12 months.

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Available from: Michael B King, Aug 03, 2015
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    • "Not surprisingly, psychological approaches such as CBT have been particularly effective in treating depression in medical patients who need help addressing maladaptive beliefs about their illness that initiate and maintain depression (Bower et al., 2000; Kessler et al., 2009; Serfaty et al., 2009; Ward et al., 2000). Most studies in primary care patients have compared CBTwith control conditions such as " usual care " by the physician, a " talking control " condition, or alternative forms of therapy such as nondirective counseling (Bower et al., 2000; Katon et al., 1996; Kessler et al., 2009; Serfaty et al., 2009; Ward et al., 2000). Head-to-head comparisons of varying forms of CBT are rare. "
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    • "Researchers have assessed the clinical and cost effectiveness of various treatments for depressed patients (Bower et al., 2000, Ward et al., 2000). The effectiveness of general practitioner care with both cognitive-behaviour therapy (CBT) and non-directive counselling were all compared. "
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