Table 21:

Cost–Utility Analysis, Sequential Approach: Internet-Delivered CBT, In-Person CBT, and Usual Care for Major Depression, From the Societal Perspective

Strategy	Mean Costs, $a,b	Mean QALYs	Incremental Costs, $b,c	Incremental QALYsd	ICER, $/QALY Gaineda
Unguided iCBT	274.53	0.777	—	—	—
Usual care	409.40	0.787	134.79	0.009	14,551
Guided iCBT	1,667.41	0.826	1,258.80	0.039	31,660
Group CBT	3,574.92	0.817	—	—	Dominated
Individual CBT	4,179.31	0.826	2,511.80	0.000	Dominatede

Abbreviations: CBT, cognitive behavioural therapy; iCBT, internet-delivered CBT; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year.

^aCosts estimated in Table 16, additional societal costs associated with in-person CBT of $2,179.

^bAll costs in 2018 Canadian dollars. No discounting was done because of the 12-month time horizon.

^cIncremental cost = average cost (strategy of guided CBT) – average cost (strategy of usual care).

^dIncremental effect = average effect (strategy of guided CBT) – average effect (strategy of usual care).

^eThis is essentially dominated by guided iCBT because, after rounding, it provides a benefit equal to that of guided iCBT but is more costly; the estimated ICER for individual CBT vs. guided iCBT would be approximately $65 million if we used an actual increment in QALYs of 0.0004.

Note: Results may appear incorrect because of rounding.