Economic evaluation of 27,540 patients with mood and anxiety disorders and the importance of waiting time and clinical effectiveness in mental healthcare
Open accessAbstract
Understanding the drivers of health and economic cost for the treatment of mental health conditions is critical to meet the accelerating demands for care. We conducted an economic evaluation of real-world healthcare-systems data from 27,540 patients receiving care for a mood or an anxiety disorder within the UK National Healthcare Service. Using Markov models built on discrete health states to compare the cost-effectiveness of different interventions, we show that the principal drivers of healthcare cost relate to waiting times and treatment effectiveness. We find that internet-delivered cognitive behavioral therapy has a ‘dominant’ incremental cost-effectiveness ratio relative to standard care, offering similar clinical effectiveness but with shorter treatment times. In most healthcare systems, the clinical effectiveness of mental healthcare remains unquantified, and long treatment times are common. The potential for these findings to inform mental healthcare policy is substantial, particularly around immediacy of access and the importance of outcomes-focused quality management.
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Internet interventions tend to be as effective as face-to-face interventions.
“Furthermore, they tend to be as effective as face-to-face interventions [53, 56, 57].”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [57]
The Discussion (page unavailable) reports that therapist-guided internet-delivered CBT had similar treatment effectiveness to general NHS Talking Therapies services. That comparator included a range of treatments, not exclusively face-to-face care; the paper also cautions that self-guided online interventions have different outcomes. It therefore does not establish the claim for internet interventions generally versus face-to-face interventions. (LLM, conf=0.88)
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References 46 · Cited by 36
- Authors
- Catarino, A., Harper, S., Malcolm, R., Stainthorpe, A., Warren, G., Margoum, M., Hooper, J., Blackwell, A. D., & Welchman, A. E.
- Affiliations
- ieso Digital Health (UK) Ltd. (United Kingdom) (GB)
- University of York (GB)
- Dorset HealthCare University NHS Foundation Trust (GB)
- Corresponding author
- Catarino, Ana
- Venue
- Nature Mental Health
- Published
- 2023-08-31
- Volume
- 1
- Issue
- 9
- Pages
- 667-678
- ISSN
- 2731-6076 (ISSN-L)
- OpenAlex
- W4386324967
- Cited by
- 36
- References
- 46
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 8 · 2023: 4
- FWCI
- 7.34
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Nature Mental Health (publishedVersion, cc-by)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- mood disorders, anxiety disorders, cost-effectiveness, waiting time, internet-based cognitive behavioral therapy, treatment effectiveness, treatment duration, mental health policy, National Health Service
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