Table 2c:

Results of Economic Literature Review—Summary: Cost-Effectiveness of Outpatient Models of Care for Providing In-Person CBT for the Treatment of Major Depressive Disorder and/or Generalized Anxiety Disorder

Name, Year, Location	Study Design and Perspective	Population and Comparator	Interventions	Results
				Health Outcomes	Costs	Cost-Effectiveness
Brown et al, 2011, United Kingdom57	Type of economic analysis: individual-level cost-minimization analysis Study design: prospective cohort study, participants of a large mental health trust/specialist national psychotherapy service Perspective: UK NHS Time horizon: 3 months Discount rate: 0%	Adults aged 17 years+ (mean age, intervention vs. control: 36.8 [SD: 10.1] vs. 44.9 [SD: 10.1] years) with MDD Total N: 93 Females (%): 73% Cohort divided into 2 groups based on clinician referral On average, participants had lived 16+ years depression, with 2–3 medications	Intervention: Individual face-to-face CBT (n = 49) Control: group CBT (n = 44) CBT: individual, 6–18 weekly sessions; group, 10–12 weekly sessions with 8–12 participants	Total QALYs (mean/person): NR Individual and group CBT equally effective in clinical outcomes	Currency, cost year: £, 2005 Total costs, individual vs. group CBT: £622 (SD: 271) vs. £737 (SD: 271) Mean difference: £115 (P = .30) Study treatment costs, individual vs. group CBT: £456.7 (SD: 190) vs. £283.5 (SD: 79; P = .001)	Base case analysis: no differences in total costs (including both treatment and support costs) between group and individual CBT
Vos et al, 2005, Australia56	Type of economic analysis: cost-effectiveness analysis Study design: decision analytic (modelling) analysis Perspective: Australia, health system perspective including indirect costs Time horizon: 5 years Discount rate: 3%	Adults aged 18+ years, ≥ 1 MDE Total N: NA Model features: MDD duration, time to next MDE and MDE severity, using acute and continuation phases of treatment Outcomes: years of life with disability, years of life lost, DALYs	7 interventions: (1)TCA during acute phase and 6-month continuation phase (2)SSRI during acute phase and 6-month continuation phase (3)CBT during acute phase and 6-month continuation phase, by a psychologist or psychiatrist, public or private setting, individual or group therapy (4)Bibliotherapy during acute phase (5)Maintenance with TCA for 5 years following acute MDE (6)Maintenance with SSRI for 5 years following acute MDE (7)Maintenance with CBT with booster sessions over 5 years following acute MDE Control: NA CBT: 12 sessions during acute phase	Total years of life lost, in thousands, for 7 interventions: (1)2.1 (2)2.1 (3)3.0 (4)0.3 (5)21 (6)22 (7)23	Currency, cost year: AUD, 2000 Total costs, in millions, 7 interventions: (1)$51 (2)$120 (3)$21 (group CBT, public setting) to $130 (individual CBT, public or private setting, psychiatrist) (4)$1.4 (5)$640 (6)$1,900 (7)$67 (group CBT, public setting) to $540 (individual CBT, private setting, psychiatrist)	Base case analysis, health system perspective: bibliotherapy, group CBT, individual CBT by psychologist on public salary, and TCA have ICERs below $10,000/DALY Maintenance treatment with SSRIs is the most expensive option: ICER $20,000/DALY
Heuzenroeder et al, 2004, Australia55	Type of economic analysis: cost-effectiveness analysis Study design: decision analytic (modelling) analysis Perspective: Australia, health system perspective including indirect costs Time horizon: 12 months Discount rate: 0%	Adults 18+ years with GAD Total N: NA Outcomes: years of life with disability, years of life lost, DALYs	5 interventions: (1)CBT by psychologist, private setting (2)CBT by psychologist, public setting (3)CBT by psychiatrist, private setting (4)CBT by psychiatrist, public setting (5)SNRI (venlafaxine, 75 or 150 mg/day) Comparator: current practice, consultation with mental health provider, based on national data CBT: acute phase, 12 1-hour sessions	Total DALYs compared with current practice: (1)CBT, private psychologist: 7,200 (2)CBT, public psychologist: 7,200 (3)CBT, private psychiatrist: 7,200 (4)CBT, public psychiatrist: 7,200 (5)SNRI: 3,300	Currency, cost year: AUD, 2000 Total costs, in millions: (1)CBT, private psychologist: $140 (2)CBT, public psychologist: $50 (3)CBT, private psychiatrist: $170 (4)CBT, public psychiatrist: $160 (5)SNRI: $77	Base case analysis, health system perspective, vs. current practice, ICER ($ thousands/DALYs): (1)CBT, private psychologist: $28 (2)CBT, public psychologist: $12 (3)CBT, private psychiatrist: $32 (4)CBT, public psychiatrist: $31 (5)SNRI: $30

Abbreviations: CBT, cognitive behavioural therapy; DALY, disability-adjusted life-year; GAD, general anxiety disorder; ICER, incremental cost-effectiveness ratio; MDD, major depressive disorder; MDE, major depressive episode; NA, not applicable; NHS, National Health Service; NR, not reported; QALY, quality-adjusted life-year; SD, standard deviation; SNRI, serotonin–norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.