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A pragmatic randomized waitlist-controlled effectiveness and cost-effectiveness trial of digital interventions for depression and anxiety |
Richards, Derek; Enrique, Angel; Eilert, Nora; Franklin, Matthew; Palacios, Jorge; Duffy, Daniel; Earley, Caroline; Chapman, Judith; Jell, Grace; Sollesse, Sarah; Timulak, Ladislav
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Utilization of internet-delivered cognitive behavioural therapy (iCBT) for treating depression and anxiety disorders in stepped-care models, such as the UK?s Improving Access to Psychological Therapies (IAPT), is a potential solution for addressing the treatment gap in mental health. We investigated the effectiveness and cost-effectiveness of iCBT when fully integrated within IAPT stepped-care settings. We conducted an 8-week pragmatic randomized controlled trial with a 2:1 (iCBT intervention: waiting-list) allocation, for participants referred to an IAPT Step 2 service with depression and anxiety symptoms (Trial registration: ISRCTN91967124). The primary outcomes measures were PHQ-9 (depressive symptoms) and GAD-7 (anxiety symptoms) and WSAS (functional impairment) as a secondary outcome. The cost-effectiveness analysis was based on EQ-5D-5L (preference-based health status) to elicit the quality-adjust life year (QALY) and a modified-Client Service Receipt Inventory (care resource-use). Diagnostic interviews were administered at baseline and 3 months. Three-hundred and sixty-one participants were randomized (iCBT, 241; waiting-list, 120). Intention-to-treat analyses showed significant interaction effects for the PHQ-9 (b?=??2.75, 95% CI ?4.00, ?1.50) and GAD-7 (b?=??2.79, 95% CI ?4.00, ?1.58) in favour of iCBT at 8-week and further improvements observed up to 12-months. Over 8-weeks the probability of cost-effectiveness was 46.6% if decision makers are willing to pay ?30,000 per QALY, increasing to 91.2% when the control-arm?s outcomes and costs were extrapolated over 12-months. Results indicate that iCBT for depression and anxiety is effective and potentially cost-effective in the long-term within IAPT. Upscaling the use of iCBT as part of stepped care could help to enhance IAPT outcomes. The pragmatic trial design supports the ecological validity of the findings.
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Keyword(s):
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Depression; Anxiety; iCBT; Internet-delivered interventions; Internet-delivered cognitive behavioural therapy; Anxiety disorders; Digital Engagement; ANXIETY; DEPRESSION; Mental Health/Psychosocial disability |
Publication Date:
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2020 |
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Type:
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Journal article |
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Peer-Reviewed:
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Yes |
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Language(s):
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English |
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Institution:
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Trinity College Dublin |
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Citation(s):
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Richards, D., Enrique, A., Eilert, N., Franklin, M., Palacios, J., Duffy, D., Earley, C., Chapman, J., Jell, G., Sollesse, S. & Timulak, L., A pragmatic randomized waitlist-controlled effectiveness and cost-effectiveness trial of digital interventions for depression and anxiety., npj Digital Medicine, 2020, 1 - 10 |
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Related Link(s):
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https://www.nature.com/articles/s41746-020-0293-8 |
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First Indexed:
2020-06-19 07:46:06 Last Updated:
2020-10-30 07:43:47 |
