Blended vs. face-to-face cognitive behavioural treatment for major depression in specialized mental health care: study protocol of a randomized controlled cost-effectiveness trial
Open accessAbstract
BACKGROUND: Depression is a prevalent disorder, associated with a high disease burden and substantial societal, economic and personal costs. Cognitive behavioural treatment has been shown to provide adequate treatment for depression. By offering this treatment in a blended format, in which online and face-to-face treatment are combined, it might be possible to reduce the number of costly face-to-face sessions required to deliver the treatment protocol. This could improve the cost-effectiveness of treatment, while maintaining clinical effects. This protocol describes the design of a pilot study for the evaluation of the feasibility, acceptability and cost-effectiveness of blended cognitive behavioural therapy for patients with major depressive disorder in specialized outpatient mental health care. METHODS/DESIGN: In a randomized controlled trial design, adult patients with major depressive disorder are allocated to either blended cognitive behavioural treatment or traditional face-to-face cognitive behavioural treatment (treatment as usual). We aim to recruit one hundred and fifty patients. Blended treatment will consist of ten face-to-face and nine online sessions provided alternately on a weekly basis. Traditional cognitive behavioural treatment will consist of twenty weekly sessions. Costs and effects are measured at baseline and after 10, 20 and 30 weeks. Evaluations are directed at cost-effectiveness (with depression severity and diagnostic status as outcomes), and cost-utility (with costs per quality adjusted life year, QALY, as outcome). Costs will encompass health care uptake costs and productivity losses due to absence from work and lower levels of efficiency while at work. Other measures of interest are mastery, working alliance, treatment preference at baseline, depressive cognitions, treatment satisfaction and system usability. DISCUSSION: The results of this pilot study will provide an initial insight into the feasibility and acceptability of blended cognitive behavioural treatment in terms of clinical and economic outcomes (proof of concept) in routine specialized mental health care settings, and an indication as to whether a well-powered clinical trial of blended cognitive behavioural treatment for depression in routine practice would be advisable. This will be determined based on the perspective of various stakeholders including patients, mental health service providers and health insurers. Strengths and limitations of the study are discussed. TRIAL REGISTRATION: Netherlands Trial Register NTR4650 . Registered 18 June 2014.
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The optimal level of support, the nature of support, and essential preconditions to make blended care acceptable and cost-effective have not been studied.
“The optimal level of support, the nature of the support, and essential preconditions to make blended care acceptable and cost-effective have not been studied as well [11,10,22].”
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- Authors
- Kooistra, L. C., Wiersma, J. E., Ruwaard, J., van Oppen, P., Smit, F., Lokkerbol, J., Cuijpers, P., & Riper, H.
- Affiliations
- Amsterdam Public Health (NL)
- Trimbos Institute (NL)
- Leuphana University of Lüneburg (DE)
- Corresponding author
- Kooistra, Lisa C
- ORCID
- Venue
- BMC Psychiatry
- Published
- 2014-10-18
- Volume
- 14
- Issue
- 1
- Pages
- 290-290
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC4209039
- OpenAlex
- W2101536400
- Cited by
- 82
- References
- 81
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 2 · 2022: 1 · 2021: 8 · 2020: 11 · 2019: 10 · 2018: 13 · 2017: 11 · 2016: 8 · 2015: 8 · 2014: 2
- FWCI
- 15.03
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- Multilingual Matters (Channel View Publications) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- ZonMw (837001007)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, online therapy, face-to-face therapy, cost-effectiveness, cost-utility analysis, quality-adjusted life years, productivity loss, feasibility and acceptability, treatment satisfaction, therapeutic relationship, depressive cognitions
- MeSH terms
- Adult, Clinical Protocols, Cost-Benefit Analysis, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Mental Health Services, Middle Aged, Netherlands, Pilot Projects, Cognitive Behavioral Therapy, Single-Blind Method
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