dc.contributor.author | Wiles, NJ | |
dc.contributor.author | Thomas, L | |
dc.contributor.author | Turner, N | |
dc.contributor.author | Garfield, K | |
dc.contributor.author | Kounali, D | |
dc.contributor.author | Campbell, John | |
dc.contributor.author | Kessler, David | |
dc.contributor.author | Kuyken, W | |
dc.contributor.author | Lewis, Glyn | |
dc.contributor.author | Morrison, J | |
dc.contributor.author | Williams, C | |
dc.contributor.author | Peters, TJ | |
dc.contributor.author | Hollinghurst, SP | |
dc.date.accessioned | 2016-02-01T14:27:12Z | |
dc.date.issued | 2016-01-07 | |
dc.description.abstract | Background: Cognitive behavioural therapy (CBT) is an effective treatment for people whose depression has not responded to antidepressants. However, the long-term outcome is unknown. In a long-term follow-up of the CoBalT trial, we examined the clinical and cost-effectiveness of cognitive behavioural therapy as an adjunct to usual care that included medication over 3-5 years in primary care patients with treatment-resistant depression. Methods: CoBalT was a randomised controlled trial done across 73 general practices in three UK centres. CoBalT recruited patients aged 18-75 years who had adhered to antidepressants for at least 6 weeks and had substantial depressive symptoms (Beck Depression Inventory [BDI-II] score ≥14 and met ICD-10 depression criteria). Participants were randomly assigned using a computer generated code, to receive either usual care or CBT in addition to usual care. Patients eligible for the long-term follow-up were those who had not withdrawn by the 12 month follow-up and had given their consent to being re-contacted. Those willing to participate were asked to return the postal questionnaire to the research team. One postal reminder was sent and non-responders were contacted by telephone to complete a brief questionnaire. Data were also collected from general practitioner notes. Follow-up took place at a variable interval after randomisation (3-5 years). The primary outcome was self-report of depressive symptoms assessed by BDI-II score (range 0-63), analysed by intention to treat. Cost-utility analysis compared health and social care costs with quality-adjusted life-years (QALYs). This study is registered with isrctn.com, number ISRCTN38231611. Findings: Between Nov 4, 2008, and Sept 30, 2010, 469 eligible participants were randomised into the CoBalT study. Of these, 248 individuals completed a long-term follow-up questionnaire and provided data for the primary outcome (136 in the intervention group vs 112 in the usual care group). At follow-up (median 45·5 months [IQR 42·5-51·1]), the intervention group had a mean BDI-II score of 19·2 (SD 13·8) compared with a mean BDI-II score of 23·4 (SD 13·2) for the usual care group (repeated measures analysis over the 46 months: difference in means -4·7 [95% CI -6·4 to -3·0, p<0·001]). Follow-up was, on average, 40 months after therapy ended. The average annual cost of trial CBT per participant was £343 (SD 129). The incremental cost-effectiveness ratio was £5374 per QALY gain. This represented a 92% probability of being cost effective at the National Institute for Health and Care Excellence QALY threshold of £20 000. Interpretation: CBT as an adjunct to usual care that includes antidepressants is clinically effective and cost effective over the long-term for individuals whose depression has not responded to pharmacotherapy. In view of this robust evidence of long-term effectiveness and the fact that the intervention represented good value-for-money, clinicians should discuss referral for CBT with all those for whom antidepressants are not effective. Funding: National Institute for Health Research Health Technology Assessment. | en_GB |
dc.description.sponsorship | National Institute for Health Research Health Technology Assessment | en_GB |
dc.identifier.citation | The Lancet Psychiatry, 2016 | en_GB |
dc.identifier.doi | 10.1016/S2215-0366(15)00495-2 | |
dc.identifier.grantnumber | 06/404/501 | en_GB |
dc.identifier.other | S2215-0366(15)00495-2 | |
dc.identifier.uri | http://hdl.handle.net/10871/19482 | |
dc.language.iso | en | en_GB |
dc.publisher | Elsevier | en_GB |
dc.relation.url | http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00495-2/abstract | en_GB |
dc.rights | © Wiles et al. Open Access article distributed under the terms of CC BY. | en_GB |
dc.title | Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: Follow-up of the CoBalT randomised controlled trial | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2016-02-01T14:27:12Z | |
dc.identifier.issn | 2215-0366 | |
dc.description | Accepted | en_GB |
dc.description | Article in Press | en_GB |
dc.description | This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record. | en_GB |
dc.identifier.journal | The Lancet Psychiatry | en_GB |