Cost-utility analysis of integrated therapist and online CBT over and above usual care for patients with depression in primary care: an economic evaluation of the INTERACT randomised controlled trial
In brief
Integrated CBT costs GBP 30,576 per added quality-adjusted life-year, with uncertainty
Over 12 months, integrated online and therapist-led cognitive behavioral therapy cost GBP 30,576 per quality-adjusted life-year gained compared with usual care, from the UK health and social care perspective. Its estimated chance of being cost-effective ranged from 26% to 50% at commonly used thresholds, so the findings do not firmly support adoption as a standalone treatment without evidence of longer-term value.
- Journal
- BMJ mental health (Q1)
- Published
- 22 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Jinshuo Li, Steve Parrott, Stephanie MacNeill, Debbie Tallon, Laura Thomas, Sally Brabyn, et al.
- PMID
- 42914536
- DOI
- 10.1136/bmjment-2026-302884
Why clinicians should know about it
- Picked for Family Practice (top studies of the week, 1 November 2026): Evaluates cost-effectiveness of CBT for primary-care depression
- Picked for Psychiatry and Mental Health (top studies of the week, 1 November 2026): Economic evaluation of therapist-supported online CBT for depression
Abstract
Background We conducted a pragmatic, parallel two-group, multi-centre randomised controlled trial to assess an online platform that integrates the use of online cognitive behavioural therapy (CBT) materials with therapist-led sessions via instant messaging and found it clinically effective, over and above usual care. Objective To investigate cost-effectiveness of integrated CBT over and above usual care over 12 months for primary care patients with depression. Methods We undertook incremental cost-utility analyses alongside the trial. The cost components in the primary analysis were integrated CBT and usual care, and wider healthcare and social services for mental health from an NHS and personal social services (PSS) perspective. The secondary analyses included costs from other perspectives. The effect was measured by quality-adjusted life years (QALYs), derived from EQ-5D-5L. A series of sensitivity analyses were performed to assess uncertainties. Findings The mean costs of integrated CBT intervention were £987 (SE £14) per participant. The incremental cost-effectiveness ratio from an NHS/PSS perspective was £30,576 per QALY gained (probability of cost-effectiveness from £25,000 to £35,000/QALY: 26% to 50%). Secondary analyses also reported higher costs in the integrated CBT group from other perspectives. Conclusions Under NICE thresholds, integrated CBT is cost-effective over and above usual care over 12 months with high decision uncertainty. Clinical implications Although integrated CBT was found clinically effective, the economic evaluation alongside the trial did not find evidence with certainty to support its implementation, over and above usual care. It should not be adopted as a standalone treatment option unless long-term cost-effectiveness is established.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.