Cost-effectiveness of different formats for delivery of cognitive behavioral therapy for depression: a systematic review based economic model
Open accessAbstract
Objectives Cognitive behavioral therapy (CBT) is an effective treatment for depression. Different CBT delivery formats (face-to-face [F2F], multimedia, and hybrid) and intensities have been used to expand access to the treatment. The aim of this study is to estimate the long-term cost-effectiveness of different CBT delivery modes.Methods A decision-analytic model was developed to evaluate the cost-effectiveness of different CBT delivery modes and variations in intensity in comparison with treatment as usual (TAU). The model covered an average treatment period of 4 months with a 5-year follow-up period. The model was populated using a systematic review of randomized controlled trials and various sources from the literature.Results Incremental cost-effectiveness ratios of treatments compared with the next best option after excluding all the dominated and extended dominated options are: £209/quality-adjusted life year (QALY) for 6 (sessions) × 30 (minutes) F2F-CBT versus TAU; £4 453/QALY for 8 × 30 F2F versus 6 × 30 F2F; £12 216/QALY for 8 × 60 F2F versus 8 × 30 F2F; and £43 072/QALY for 16 × 60 F2F versus 8 × 60 F2F. The treatment with the highest net monetary benefit for thresholds of £20 000 to £30 000/QALY was 8 × 30 F2F-CBT. Probabilistic sensitivity analysis illustrated 6 × 30 F2F-CBT had the highest probability (32.8%) of being cost-effective at £20 000/QALY; 16 × 60 F2F-CBT had the highest probability (31.0%) at £30 000/QALY.Conclusions All CBT delivery modes on top of TAU were found to be more cost-effective than TAU alone. Four F2F-CBT options (6 × 30, 8 × 30, 8 × 60, 16 × 60) are on the cost-effectiveness frontier. F2F-CBT with intensities of 6 × 30 and 16 × 60 had the highest probabilities of being cost-effective. The results, however, should be interpreted with caution owing to the high level of uncertainty.
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Non-specific treatments such as non-specific counselling can result in good outcomes comparable to those recorded for CBT.
“These therapies can result in good outcomes, comparable for example to those recorded for CBT. 596”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [596]
Cites
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., Rush, A. J., Walters, E. E., & Wang, P. S. (2003) · JAMA · doi:10.1001/jama.289.23.3095 · Cited by 7,988 · see citing works
Decision Modelling For Health Economic Evaluation
Briggs, A., Claxton, K., & Sculpher, M. (2006) · doi:10.1093/oso/9780198526629.001.0001 · Cited by 3,153 · see citing works
Ferrari, A. J., Charlson, F. J., Norman, R. E., Patten, S. B., Freedman, G., Murray, C. J. L., Vos, T., & Whiteford, H. A. (2013) · PLoS Medicine · doi:10.1371/journal.pmed.1001547 · Cited by 3,115 · see citing works
Global burden of depressive disorders in the year 2000
Üstün, T. B., Ayuso-Mateos, J. L., Chatterji, S., Mathers, C., & Murray, C. J. L. (2004) · British Journal of Psychiatry · doi:10.1192/bjp.184.5.386 · Cited by 1,735 · see citing works
Internet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis
Andersson, G., & Cuijpers, P. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070903318960 · Cited by 1,368 · see citing works
Pignone, M. P., Gaynes, B. N., Rushton, J. L., Burchell, C. M., Orleans, C. T., Mulrow, C. D., & Lohr, K. N. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-136-10-200205210-00013 · Cited by 1,086 · see citing works
Kessler, R. C., Nelson, C. B., McGonagle, K. A., Liu, J., Swartz, M. S., & Blazer, D. G. (1996) · The British Journal of Psychiatry · doi:10.1192/s0007125000298371 · Cited by 1,079 · see citing works
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013) · The Canadian Journal of Psychiatry · doi:10.1177/070674371305800702 · Cited by 1,066 · see citing works
Risk for recurrence in depression
Burcusa, S. L., & Iacono, W. G. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.02.005 · Cited by 1,023 · see citing works
The National Institute for Clinical Excellence (NICE)
Rodgers, A.-T. (2002) · Annals of the Rheumatic Diseases · doi:10.1136/ard.61.suppl_2.ii92 · Cited by 976 · see citing works
The Interpretation of Random-Effects Meta-Analysis in Decision Models
Ades, A. E., Lu, G., & Higgins, J. P. T. (2005) · Medical Decision Making · doi:10.1177/0272989x05282643 · Cited by 861 · see citing works
Excess mortality in depression: a meta-analysis of community studies
Cuijpers, P. J., & Smit, F. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(01)00413-x · Cited by 774 · see citing works
(2016) · City Research Online (City University London) · Cited by 747 · see citing works
Prevalence and predictors of recurrence of major depressive disorder in the adult population
Hardeveld, F., Spijker, J., De Graaf, R., Nolen, W. A., & Beekman, A. T. F. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01519.x · Cited by 486 · see citing works
DeRubeis, R. J., Gelfand, L. A., Tang, T. Z., & Simons, A. D. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.7.1007 · Cited by 449 · see citing works
Paying the price: the cost of mental health care in England to 2026
McCrone, P., Dhanasiri, S., Patel, A. K., Knapp, M. R. J., & Lawton-Smith, S. H. (2008) · Research Portal (King's College London) · Cited by 439 · see citing works
PROUDFOOT, J., GOLDBERG, D., MANN, A., EVERITT, B., MARKS, I., & GRAY, J. A. (2003) · Psychological Medicine · doi:10.1017/s0033291702007225 · Cited by 389 · see citing works
Kessler, D., Lewis, G., Kaur, S., Wiles, N., King, M., Weich, S., Sharp, D. J., Araya, R., Hollinghurst, S., & Peters, T. J. (2009) · The Lancet · doi:10.1016/s0140-6736(09)61257-5 · Cited by 387 · see citing works
Self-citationKaltenthaler, E., Brazier, J., De Nigris, E., Tumur, I., Ferriter, M., Beverley, C., Parry, G., Rooney, G., & Sutcliffe, P. (2006) · Health Technology Assessment · doi:10.3310/hta10330 · Cited by 357 · see citing works
Wiles, N., Thomas, L., Abel, A., Ridgway, N., Turner, N., Campbell, J., Garland, A., Hollinghurst, S., Jerrom, B., Kessler, D., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(12)61552-9 · Cited by 340 · see citing works
Self-citationSuicide risk in patients with major depressive disorder.
Angst, J., Angst, F., & Stassen, H. H. (1999) · PubMed · Cited by 308 · see citing works
Fenwick, E. A. L., Marshall, D. A., Levy, A. R., & Nichol, G. (2006) · BMC Health Services Research · doi:10.1186/1472-6963-6-52 · Cited by 280 · see citing works
How much psychotherapy is needed to treat depression? A metaregression analysis
Cuijpers, P., Huibers, M., Daniel Ebert, D., Koole, S. L., & Andersson, G. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.02.030 · Cited by 258 · see citing works
Richardson, G., & Manca, A. (2004) · Health Economics · doi:10.1002/hec.901 · Cited by 251 · see citing works
Gaynes, B. N., West, S. L., Ford, C. A., Frame, P., Klein, J. D., & Lohr, K. N. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-10-200405180-00015 · Cited by 175 · see citing works
López-López, J. A., Davies, S. R., Caldwell, D. M., Churchill, R., Peters, T. J., Tallon, D., Dawson, S., Wu, Q., Li, J., Taylor, A., et al. (2019) · Psychological Medicine · doi:10.1017/s003329171900120x · Cited by 161 · see citing works
Self-citationPaganini, S., Teigelkötter, W., Buntrock, C., & Baumeister, H. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.07.018 · Cited by 144 · see citing works
Wiles, N. J., Thomas, L., Turner, N., Garfield, K., Kounali, D., Campbell, J., Kessler, D., Kuyken, W., Lewis, G., Morrison, J., et al. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00495-2 · Cited by 139 · see citing works
Self-citationEvidence of cost-effective treatments for depression: a systematic review
Barrett, B. M., Byford, S., & Knapp, M. R. J. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2004.10.003 · Cited by 122 · see citing works
Dose–effect relationship in routine outpatient psychotherapy: Does treatment duration matter?
Stulz, N., Lutz, W., Kopta, S. M., Minami, T., & Saunders, S. M. (2013) · Journal of Counseling Psychology · doi:10.1037/a0033589 · Cited by 112 · see citing works
Cost-Utility Analysis Studies of Depression Management: A Systematic Review
Pirraglia, P. A., Rosen, A. B., Hermann, R. C., Olchanski, N., & Neumann, P. J. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.12.2155 · Cited by 80 · see citing works
GEOGRAPHIC INEQUITY IN THE AVAILABILITY OF COGNITIVE BEHAVIOURAL THERAPY IN ENG LAND AND WALES
Shapiro, D. A., Cavanagh, K., & Lomas, H. (2003) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465803002066 · Cited by 75 · see citing works
Long term outcome of primary care depression
Yiend, J., Paykel, E., Merritt, R., Lester, K., Doll, H., & Burns, T. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.01.026 · Cited by 67 · see citing works
Depression in primary care: assessing suicide risk
Ng, C., How, C., & Ng, Y. (2017) · Singapore Medical Journal · doi:10.11622/smedj.2017006 · Cited by 50 · see citing works
Cost-Utility Analyses of Cognitive-Behavioural Therapy of Depression: A Systematic Review
Brettschneider, C., Djadran, H., Härter, M. C., Löwe, B., Riedel-Heller, S. G., & König, H. (2014) · Psychotherapy and Psychosomatics · doi:10.1159/000365150 · Cited by 40 · see citing works
Cuijpers, P., & Gentili, C. (2017) · Research in Psychotherapy: Psychopathology, Process and Outcome · doi:10.4081/ripppo.2017.273 · Cited by 24 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104 · see citing works
Nakao, M., Shirotsuki, K., & Sugaya, N. (2021) · BioPsychoSocial Medicine · doi:10.1186/s13030-021-00219-w · Cited by 339 · see citing works
“The treatment outcomes and health insurance costs for these six disorders should be analyzed as the first step, for appropriate allocation of medical resources according to disease severity and complexity [18].”
BackgroundThe significance of cognitive-behavioral therapy on suicide: An umbrella review
Wu, H., Liu, L., Qian, Y., Jin, X., Yu, H., Du, L., Fu, X., Zhu, B., & Chen, H. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.08.067 · Cited by 57 · see citing works
Economic Evaluation of Cognitive Behavioral Therapy for Depression: A Systematic Review
Li, M., Bai, F., Yao, L., Yu, Q., Chen, K., Xin, T., Ma, X., Ma, Y., Zhou, Y., Dai, H., et al. (2022) · Value in Health · doi:10.1016/j.jval.2021.11.1379 · Cited by 16 · see citing works
Digitalizing Public Services: Opportunities for Latin America and the Caribbean
Cristia, J., & Vlaicu, R. (2022) · doi:10.18235/0004543 · Cited by 21 · see citing works
Tallon, D., Thomas, L., Brabyn, S., Ching, B. C. F., Hahn, J. S., Jude, B., Logan, M. X., Burrage, A., Fox, F. E., Gilbody, S. M., et al. (2023) · Trials · doi:10.1186/s13063-023-07396-9 · Cited by 6 · see citing works
“The first stage focused on: identifying clinical and cost-effective components of CBT to inform the design of the intervention [14, 15] development of an online platform for delivering integrated highintensity CBT for depression and gathering additional design ideas [16, 17] and feedback from key stakeholders such as…”
BackgroundSelf-citationVollbehr, N. K., Stant, A. D., Hoenders, R. H. J., Bartels‐Velthuis, A. A., Nauta, M. H., Castelein, S., Schroevers, M. J., de Jong, P. J., & Ostafin, B. D. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115692 · Cited by 6 · see citing works
“Among standard treatments for depression, cost-effectiveness analyses have been conducted and shown benefits for anti-depressant medication (Khoo et al., 2015; Ramsberg et al., 2012) and CBT (Wu et al., 2020).”
BackgroundA Cost-Benefit Analysis of Selected Digital Projects in Latin America and the Caribbean
Cristia, J., Bernal, P., Santamaría, J., Algarra, P., Bernal, C., Escalante, L., Gallegos, A., Irazoque, N., Ortiz, E. A., Gambi, G. D. N., et al. (2022) · doi:10.18235/0004525 · Cited by 4 · see citing works
The implications of the COVID-19 pandemic for clinical mental health care
Schuster, A., Alwan, N. A., Callard, F. J., Chen, E. Y. H., Gilbody, S. M., Graham, B. M., Hatch, S. L., Jones, E. Y., Jordan, A., Knapp, M. R. J., et al. (2026) · The Lancet Psychiatry · doi:10.1016/s2215-0366(25)00247-0 · Cited by 2 · see citing works
Lima, R. A., Baumeister, H., Pryss, R., Küchler, A., Kraft, R., Berghoff, N., Nagel, L., Reichert, M., Idrees, A. R., Stach, M., et al. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-108674 · Cited by 1 · see citing works
“27 28 A key feature of the programme is its modular structure, which allows for the flexible use of individual components or the full suite of resources.”
Tallon, D., Thomas, L., Brabyn, S., Ching, B. C. F., Fox, F. E., Hahn, J. S., Jude, B., Li, J., López-López, J. A., Stawarz, K., et al. (2025) · Programme Grants for Applied Research · doi:10.3310/gjnw3912 · Cited by 1 · see citing works
Self-citationCognitive behavioural therapy at various delivery modes cost effective
(2020) · PharmacoEconomics & Outcomes News · doi:10.1007/s40274-020-7161-2
CBT for Anxiety and Depression: The ‘Gold Standard’ of Therapy or A Convenient Illusion?
Mustafa, E. S. (2025) · PsyPag Quarterly · doi:10.53841/bpspag.2025.1.128.13
Hamashima, Y., Breheny, K., Davies, S. R., Dawson, S., Thornton, Z. A., Aiton, E., Caldwell, D. M., Christensen, H., Higgins, J. P. T., Yates, J., et al. (2025) · Vaccine · doi:10.1016/j.vaccine.2025.127906
Self-citationHallajian, F., Jamshidi, E., Sayarifard, A., Ghadirian, L., & Ahmadi, A. (2025) · Trials · doi:10.1186/s13063-025-09252-4
“Multiple interventions have proven effective in reducing depression, including pharmacotherapy, cognitive behavioral therapy (CBT), and collaborative care models, many of which are cost-effective across diverse settings [15].”
Hu, M., Li, M., Liu, Q., Luo, Z., Zhang, Y., Niu, Y., Jiang, X., & Yang, K. (2025) · Journal of General Internal Medicine · doi:10.1007/s11606-025-09944-2
Tallon, D., Thomas, L., Brabyn, S., Ching, B. C. F., Hahn, J. S., Jude, B., Logan, M. X., Burrage, A., Fox, F. E., Gilbody, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26598524
Self-citationde la Cuadra-Grande, A., Oltra-Díaz, M., de Antonio, M. L., Casado, M. Á., & Oyagüez, I. (2025) · Applied Health Economics and Health Policy · doi:10.1007/s40258-025-01022-2
Li, T., Zhang, S., Ding, X., Zhu, M., Chen, H., Luo, Z., Wei, W., & Li, Z. (2026) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2026.08.015
- Authors
- Wu, Q., Li, J., Parrott, S., López-López, J. A., Davies, S. R., Caldwell, D. M., Churchill, R. C., Peters, T. J., Lewis, G., Tallon, D., Dawson, S., Taylor, A., Kessler, D. S., Wiles, N., & Welton, N. J.
- Affiliations
- University of York (GB)
- Universidad de Murcia (ES)
- University of Bristol (GB)
- University College London (GB)
- Corresponding author
- Wu, Qi
- ORCID
- Venue
- Value in Health
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 23
- Issue
- 12
- Pages
- 1662-1670
- ISSN
- 1098-3015 (ISSN-L)
- OpenAlex
- W3048942964
- Cited by
- 19
- References
- 36
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 1 · 2023: 2 · 2022: 5 · 2021: 1 · 2020: 1
- FWCI
- 0.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Value in Health (publishedVersion)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion, cc-by-nc-nd)
- Bristol Research (University of Bristol) (acceptedVersion, cc-by-nc-nd)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health Research
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- cognitive behavioral therapy, depression, cost-effectiveness, treatment delivery format, face-to-face therapy, hybrid therapy, treatment intensity, quality-adjusted life years, net monetary benefit, decision-analytic model, access to mental health care, long-term outcomes, treatment as usual comparison, probabilistic sensitivity analysis, health technology assessment
- MeSH terms
- Cost-Benefit Analysis, Depression, Humans, Cognitive Behavioral Therapy, Health Care Costs, Models, Economic
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