Economic evaluation of online computerised cognitive-behavioural therapy without support for depression in primary care: Randomised trial

Gerhards, S. A. H.; de Graaf, L. E.; Jacobs, L. E.; Severens, J. L.; Huibers, M. J. H.; Arntz, A.; Riper, H.; Widdershoven, G.; Metsemakers, J. F. M.; Evers, S. M. A. A.

doi:10.1192/bjp.bp.109.065748

Cited by 135Digital Mental Health InterventionsHealth Systems, Economic Evaluations, Quality of LifeAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Economic evaluation of online computerised cognitive-behavioural therapy without support for depression in primary care: Randomised trial

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Gerhards, S. A. H., de Graaf, L. E., Jacobs, L. E., Severens, J. L., Huibers, M. J. H., Arntz, A., Riper, H., Widdershoven, G. +2 more·2010·British Journal of Psychiatry

DOI 10.1192/bjp.bp.109.065748

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Abstract

Background: Evidence about the cost-effectiveness and cost utility of computerised cognitive–behavioural therapy (CCBT) is still limited. Recently, we compared the clinical effectiveness of unsupported, online CCBT with treatment as usual (TAU) and a combination of CCBT and TAU (CCBT plus TAU) for depression. The study is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236). Aims: To assess the cost-effectiveness of CCBT compared with TAU and CCBT plus TAU. Method: Costs, depression severity and quality of life were measured for 12 months. Cost-effectiveness and cost-utility analyses were performed from a societal perspective. Uncertainty was dealt with by bootstrap replications and sensitivity analyses. Results: Costs were lowest for the CCBT group. There are no significant group differences in effectiveness or quality of life. Cost-utility and cost-effectiveness analyses tend to be in favour of CCBT. Conclusions: On balance, CCBT constitutes the most efficient treatment strategy, although all treatments showed low adherence rates and modest improvements in depression and quality of life.

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Benefits of web-based self-help interventions include 24/7 availability, anonymous access to the materials, wider distribution, and cost-effectiveness.
“Benefits of web-based self-help interventions also include 24/7 availability, anonymous access to the materials, their wider distribution (Muñoz, 2010; Napolitano & Marcus, 2002), and their cost-effectiveness (Gerhards et al., 2010; Mihalopoulos et al., 2005).”
From Self-help interventions to reduce self-stigma in people with mental health problems: A systematic literature review (2020) · cites this paper as Gerhards et al., 2010
Economic evaluation studies on e-self-help for depression show favorable results in primary care and among depressed persons in the community.
“but economic evaluation studies on e-self-help for depression show favorable results as shown by a recent study of Gerhards and colleagues [73] in primary care and by Warmerdam and colleagues among depressed persons in the community [74].”
From Effectiveness of E-self-help interventions for curbing adult problem drinking: a meta-analysis (2011) · cites this paper as [73]

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BackgroundSelf-citation
Acceptability of psychological treatment to Chinese- and Caucasian-Australians: Internet treatment reduces barriers but face-to-face care is preferred
Choi, I., Sharpe, L., Li, S., & Hunt, C. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0921-1 · Cited by 64 · see citing works
“the efficacy [4–6], effectiveness [7], and cost-effectiveness [8, 9] of Internet-delivered cognitive behavioural therapy (iCBT) for depression and anxiety, there is relatively little I.”
Background
Improving Cost-effectiveness and Access to Cognitive Behavior Therapy for Depression: Providing Remote-Ready, Computer-Assisted Psychotherapy in Times of Crisis and Beyond
Thase, M. E., McCrone, P., Barrett, M. S., Eells, T. D., Wisniewski, S. R., Balasubramani, G. K., Brown, G. K., & Wright, J. H. (2020) · Psychotherapy and Psychosomatics · doi:10.1159/000508143 · Cited by 60 · see citing works
“…of earlier studies included the components necessary to assess cost-effectiveness in comparison to standard, first-line interven-Table tions (i.e., randomization to a credible, active comparison group and a detailed assessment of service utilization, costs, and lost economic potential) [36–41].”
Background
Economic Evaluation of a Web-Based Tailored Lifestyle Intervention for Adults: Findings Regarding Cost-Effectiveness and Cost-Utility From a Randomized Controlled Trial
Schulz, D. N., Smit, E. S., Stanczyk, N. E., Kremers, S., de Vries, H., & Evers, S. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3159 · Cited by 63 · see citing works
“Some economic evaluations of Web-based and/or computer-tailored programs have been conducted to date (eg, [18-23]).”
Self-citation
Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation
Leaviss, J., Davis, S., Ren, S., Hamilton, J., Scope, A., Booth, A., Sutton, A., Parry, G. D., Buszewicz, M., Moss-Morris, R. E., et al. (2020) · Health Technology Assessment · doi:10.3310/hta24460 · Cited by 67 · see citing works
Systematic review of economic evaluations for internet- and mobile-based interventions for mental health problems
Kählke, F., Buntrock, C., Smit, F., & Ebert, D. D. (2022) · npj Digital Medicine · doi:10.1038/s41746-022-00702-w · Cited by 66 · see citing works
An Economic Evaluation of a Video- and Text-Based Computer-Tailored Intervention for Smoking Cessation: A Cost-Effectiveness and Cost-Utility Analysis of a Randomized Controlled Trial
Stanczyk, N. E., Smit, E. S., Schulz, D. N., de Vries, H., Bolman, C. A. W., Muris, J. W. M., & Evers, S. (2014) · PLoS ONE · doi:10.1371/journal.pone.0110117 · Cited by 58 · see citing works
“Although the WTP of J18,000 is an accepted Dutch-cutoff point for measuring the QALY [55], past research has suggested varying these WTP values [56].”
Self-citation
e-CBT (myCompass), Antidepressant Medication, and Face-to-Face Psychological Treatment for Depression in Australia: A Cost-Effectiveness Comparison
Solomon, D., Proudfoot, J., Clarke, J., & Christensen, H. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4207 · Cited by 55 · see citing works
“Previous studies have found similarly moderate results in incremental effectiveness to those reported here [11,13,14,16] but also found that the majority of costs were attributable to productivity and societal costs, with higher ICERs.”
Cost-effectiveness of Internet Interventions Compared With Treatment as Usual for People With Mental Disorders: Systematic Review and Meta-analysis of Randomized Controlled Trials
Rohrbach, P. J., Dingemans, A. E., Evers, C., van Furth, E. F., Spinhoven, P., Aardoom, J. J., Lähde, I., Clemens, F. C., & Marle, M. E. V. D. A. (2022) · Journal of Medical Internet Research · doi:10.2196/38204 · Cited by 55 · see citing works
“Buntrock et al [44], Dixon et al [48], Duarte et al [49], Geraedts et al [51], Gerhards et al [52], Hollinghurst et al [53], Holst et al [54], Kolovos et al [59], Kraepelien et al [60], Nobis et al [68], 16 Depression”
BackgroundInfluential
Privacy issues in the development of a virtual mental health clinic for university students: a qualitative study
Gulliver, A., Bennett, K., Bennett, A., Farrer, L. M., Reynolds, J., & Griffiths, K. M. (2015) · JMIR Mental Health · doi:10.2196/mental.4294 · Cited by 50 · see citing works
“Interventions delivered via the internet can be continuously available, accessed anonymously, cost-effective [15,16], scalable, and broadly disseminated [17,18].”
Digital interventions in mental health: Evidence syntheses and economic modelling
Gega, L., Jankovic, D., Saramago, P., Marshall, D., Dawson, S., Brabyn, S., Nikolaidis, G. F., Melton, H., Churchill, R., & Bojke, L. (2022) · Health Technology Assessment · doi:10.3310/rcti6942 · Cited by 48 · see citing works
Effectiveness of blended depression treatment for adults in specialised mental healthcare: study protocol for a randomised controlled trial
Kemmeren, L., van Schaik, A., Riper, H. M., Kleiboer, A. M., Bosmans, J. E., & Smit, J. H. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0818-5 · Cited by 49 · see citing works
Self-citation
Web-based intervention for depressive symptoms in adults with types 1 and 2 diabetes mellitus: a health economic evaluation
Nobis, S., Ebert, D. D., Lehr, D., Smit, F., Buntrock, C., Berking, M., Baumeister, H., Snoek, F., Funk, B., & Riper, H. (2018) · The British Journal of Psychiatry · doi:10.1192/bjp.2018.10 · Cited by 43 · see citing works
Self-citation
One-year follow-up results of unsupported online computerized cognitive behavioural therapy for depression in primary care: A randomized trial
de Graaf, L. E., Gerhards, S. A. H., Arntz, A. R., Riper, H. M., Metsemakers, J. F. M., Evers, S., Severens, J. L., Widdershoven, G. A. M., & Huibers, M. J. H. (2010) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2010.07.003 · Cited by 46 · see citing works
“with our full economic evaluation of this study, which showed that the costs were lowest for CCBT alone (Gerhards et al., 2010).”
MethodSelf-citation
Economic Evaluation of Internet-Based Interventions for Harmful Alcohol Use Alongside a Pragmatic Randomized Controlled Trial
Blankers, M., Nabitz, U. W., Smit, F., Koeter, M. W. J., & Schippers, G. M. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.2052 · Cited by 42 · see citing works
“Therefore, development costs were to a large extent running costs, and it is common in eHealth cost effectiveness studies to include these costs in the cost analysis (eg, [12-14]).”
Background
Internet-Based Interventions for Women’s Sexual Dysfunction
van Lankveld, J. J. D. M. (2016) · Current Sexual Health Reports · doi:10.1007/s11930-016-0087-9 · Cited by 42 · see citing works
Internet-based relapse prevention for anorexia nervosa: nine- month follow-up
Fichter, M. M., Quadflieg, N., & Lindner, S. (2013) · Journal of Eating Disorders · doi:10.1186/2050-2974-1-23 · Cited by 41 · see citing works
“Other controlled studies have dealt with internet-based psychotherapy for posttraumatic stress disorder [11], anxiety disorders [12] including panic disorder and various phobias, and depression [13].”
Background
Exploring the Role of Persuasive Design in Unguided Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Adults: Systematic Review, Meta-analysis, and Meta-regression
McCall, H. C., Hadjistavropoulos, H. D., & Sundström, C. (2021) · Journal of Medical Internet Research · doi:10.2196/26939 · Cited by 39 · 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
Cost–Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation
Baumann, M., Stargardt, T., & Frey, S. (2020) · Applied Health Economics and Health Policy · doi:10.1007/s40258-019-00551-x · Cited by 38 · see citing works
“Another Dutch study [28] evaluated the cost effectiveness of unguided ICBT alone or in combination with treatment as usual compared to treatment as usual alone.”
Background
Qualitative Synthesis of Young People’s Experiences With Technology-Assisted Cognitive Behavioral Therapy: Systematic Review
McCashin, D., Coyle, D., & O’Reilly, G. (2019) · Journal of Medical Internet Research · doi:10.2196/13540 · Cited by 37 · see citing works
Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions
Fattori, A., Neri, L., Aguglia, E., Bellomo, A., Bisogno, A., Camerino, D., Carpiniello, B., Cassin, A., Costa, G., Fazio, P. D., et al. (2015) · BioMed Research International · doi:10.1155/2015/708908 · Cited by 38 · see citing works
The Responsiveness of Quality of Life Utilities to Change in Depression: A Comparison of Instruments (SF-6D, EQ-5D, and DFD)
Gerhards, S. A. H., Huibers, M. J. H., Theunissen, K. A. T. M., de Graaf, L. E., Widdershoven, G. A. M., & Evers, S. (2011) · Value in Health · doi:10.1016/j.jval.2010.12.004 · Cited by 36 · see citing works
“47 points in score, respectively [4]; with RC improvement of 53.”
BackgroundMethodResultInfluentialSelf-citation
Considering the societal perspective in economic evaluations: a systematic review in the case of depression
Duevel, J. A., Hasemann, L., Peña-Longobardo, L. M., Rodríguez-Sánchez, B., Aranda-Reneo, I., Oliva-Moreno, J., López-Bastida, J., & Greiner, W. (2020) · Health Economics Review · doi:10.1186/s13561-020-00288-7 · Cited by 34 · see citing works
Utility Values for Adults with Unipolar Depression
Mohiuddin, S., & Payne, K. (2014) · Medical Decision Making · doi:10.1177/0272989x14524990 · Cited by 35 · see citing works
Expectations Among Patients and Health Professionals Regarding Web-Based Interventions for Depression in Primary Care: A Qualitative Study
Montero‐Marín, J., Prado-Abril, J., Botella, C., Mayoral, F., Baños, R., Herrera‐Mercadal, P., Romero‐Sanchiz, P., Gili, M., Castro, A., Nogueira‐Arjona, R., et al. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3985 · Cited by 33 · see citing works
“One of the main ones is that attrition rates could be substantial [28,43-45].”
Reducing suicidal thoughts in the Australian general population through web-based self-help: study protocol for a randomized controlled trial
van Spijker, B. A. J., Calear, A. L., Batterham, P. J., Mackinnon, A. J., Gosling, J. A., Kerkhof, A. J. F. M., Solomon, D., & Christensen, H. M. (2015) · Trials · doi:10.1186/s13063-015-0589-1 · Cited by 33 · see citing works
Economic Evaluation of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms
Geraedts, A. S., van Dongen, J. M., Kleiboer, A. M., Wiezer, N. M., van Mechelen, W., Cuijpers, P. J., & Bosmans, J. E. (2015) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000000423 · Cited by 32 · see citing works
Effectiveness of a transdiagnostic individually tailored Internet-based and mobile-supported intervention for the indicated prevention of depression and anxiety (ICare Prevent) in Dutch college students: study protocol for a randomised controlled trial
Bolinski, F., Kleiboer, A., Karyotaki, E., Bosmans, J. E., Zarski, A.-C., Weisel, K. K., Ebert, D. D., Jacobi, C., Cuijpers, P., & Riper, H. (2018) · Trials · doi:10.1186/s13063-018-2477-y · Cited by 31 · see citing works
Self-citation
Effectiveness of two intensive treatment methods for smoking cessation and relapse prevention in patients with coronary heart disease: study protocol and baseline description
Berndt, N. C., Bolman, C. A. W., Lechner, L., Mudde, A. N., Verheugt, F. W. A., & de Vries, H. (2012) · BMC Cardiovascular Disorders · doi:10.1186/1471-2261-12-33 · Cited by 31 · see citing works
“This included counsellor time, use of materials, use of nicotine replacement patches and specialist time involved in cessation advice [92-94].”
Background
Cost-effectiveness of computerized cognitive–behavioural therapy for the treatment of depression in primary care: findings from the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial
Duarte, A., Walker, S., Littlewood, E., Brabyn, S., Hewitt, C., Gilbody, S., & Palmer, S. (2017) · Psychological Medicine · doi:10.1017/s0033291717000289 · Cited by 30 · see citing works
“…et al. 2004; Gerhards et al. 2010; Hollinghurst et al. 2010; Warmerdam et al. 2010), smaller sample size in earlier studies (McCrone et al. 2004; Gerhards et al. 2010; Hollinghurst et al. 2010; Warmerdam et al. 2010), estimation of QALYs by mapping from a depression-speci ﬁ c measure (Beck ’ s…”
BackgroundMethodResultInfluential
Cost‐utility of an internet‐based intervention with or without therapist support in comparison with a waiting list for individuals with eating disorder symptoms: a randomized controlled trial
Aardoom, J. J., Dingemans, A. E., van Ginkel, J. R., Spinhoven, P., Van Furth, E. F., & Van den Akker‐van Marle, M. E. (2016) · International Journal of Eating Disorders · doi:10.1002/eat.22587 · Cited by 30 · see citing works
The development of a randomised controlled trial testing the effects of an online intervention among school students at risk of suicide
Robinson, J., Hetrick, S. E., Cox, G., Bendall, S., Yung, A. R., Yuen, H. P., Templer, K., & Pirkis, J. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-155 · Cited by 30 · see citing works
Computer-Assisted CBT and Mobile Apps for Depression: Assessment and Integration Into Clinical Care
Wright, J. H., & Mishkind, M. C. (2020) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20190044 · Cited by 25 · see citing works
Guided Internet-Based Cognitive Behavioral Therapy for Depression: Implementation Cost-Effectiveness Study
Piera-Jiménez, J., Etzelmueller, A., Kolovos, S., Folkvord, F., & Lupiáñez‐Villanueva, F. (2021) · Journal of Medical Internet Research · doi:10.2196/27410 · Cited by 25 · see citing works
“…in the lower zone of the wide range of values reported for guided interventions (ie, €19,616 [54] to €157,900 [55]; approximately US $19,616 and $189,825, respectively) and below that of unguided interventions (ie, €40,412 [56] to €178,700 [57]; approximately US $48,583 and $214,831, respectively).”
Health economic evaluation of an internet intervention for depression (deprexis), a randomized controlled trial
Gräfe, V., Moritz, S., & Greiner, W. (2020) · Health Economics Review · doi:10.1186/s13561-020-00273-0 · Cited by 22 · see citing works
The Estimation of Utility Weights in Cost-Utility Analysis for Mental Disorders: A Systematic Review
Sonntag, M., König, H., & Konnopka, A. (2013) · PharmacoEconomics · doi:10.1007/s40273-013-0107-9 · Cited by 23 · see citing works
Low intensity vs. self-guided Internet-delivered psychotherapy for major depression: a multicenter, controlled, randomized study
del Hoyo, Y. L., Oliván‐Blázquez, B., Luciano, J. V., Mayoral, F., Roca, M., Gili, M., Andres, E. M., Serrano‐Blanco, A., Collazo, F., Araya, R., et al. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-21 · Cited by 22 · see citing works
Supportive monitoring and disease management through the internet: An internet-delivered intervention strategy for recurrent depression
Kordy, H., Backenstraß, M., Hüsing, J., Wolf, M., Aulich, K., Bürgy, M., Puschner, B., Rummel‐Kluge, C., & Vedder, H. (2013) · Contemporary Clinical Trials · doi:10.1016/j.cct.2013.08.005 · Cited by 21 · see citing works
“There is growing evidence that health services for depressive disorders can be effectively delivered online [21–30].”
Background
Potential of St John's Wort for the Treatment of Depression: The Economic Perspective
Solomon, D., Ford, E., Adams, J., & Graves, N. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048674.2010.526094 · Cited by 21 · see citing works
Economic evaluation of audio based resilience training for depression in primary care
Koeser, L., Dobbin, A., Ross, S., & McCrone, P. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.01.044 · Cited by 19 · see citing works
“The decision model contains simplifications and limitations due to lack of data availability and, therefore, it is important to not overstate the evidence in favour of PosMT (Haji Ali Afzali et al., 2012).”
Background
Using the Personalized Advantage Index for Individual Treatment Allocation to Blended Treatment or Treatment as Usual for Depression in Secondary Care
Friedl, N., Krieger, T., Chevreul, K., Hazo, J., Holtzmann, J., Hoogendoorn, M., Kleiboer, A. M., Mathiasen, K., Urech, A., Riper, H. M., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9020490 · Cited by 19 · see citing works
Self-citation
When in Doubt, Ask the Audience: Potential Users′ Perceptions of Internet‐Delivered Cognitive Behavioural Therapy for Chronic Pain
Schneider, L. H., & Hadjistavropoulos, H. D. (2014) · Pain Research and Management · doi:10.1155/2014/451373 · Cited by 19 · 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
Telepsiquiatría: una revisión sistemática cualitativa
Castro, A., Larraín, A., Rosemarie Fritsch, M., & Rojas, G. (2012) · Revista médica de Chile · doi:10.4067/s0034-98872012000600015 · Cited by 15 · see citing works
Utility of computerised cognitive–behavioural therapy for depression
Andrews, G. (2010) · British Journal of Psychiatry · doi:10.1192/bjp.bp.109.076356 · Cited by 17 · see citing works
Guided self-help on the internet for turkish migrants with depression: the design of a randomized controlled trial
Ünlü, B., Riper, H. M., van Straten, A., & Cuijpers, P. J. (2010) · Trials · doi:10.1186/1745-6215-11-101 · Cited by 14 · see citing works
“There is now convincing evidence that webbased interventions effectively reduce depressive symptoms and prevent depression [7-12] and they have been shown to be not only clinically effective, but also cost effective [ 13 ].”
BackgroundSelf-citation
Health economic evaluation of a web-based intervention for depression: the EVIDENT-trial, a randomized controlled study
Gräfe, V., Berger, T., Hautzinger, M., Hohagen, F., Lutz, W., Meyer, B., Moritz, S., Rose, M., Schröder, J., Späth, C., et al. (2019) · Health Economics Review · doi:10.1186/s13561-019-0233-y · Cited by 14 · see citing works
Occupational impact of internet‐delivered cognitive behaviour therapy for depression and anxiety: reanalysis of data from five Australian randomised controlled trials
MacKenzie, A., Harvey, S. B., Mewton, L., & Andrews, G. (2014) · Medical Journal of Australia · doi:10.5694/mja14.00293 · Cited by 13 · see citing works
Facilitating access to iCBT: a randomized controlled trial assessing a translated version of an empirically validated program using a minimally monitored delivery model
Robichaud, M., Talbot, F., Titov, N., Dear, B. F., Hadjistavropoulos, H. D., Hadjistavropoulos, T., & Jbilou, J. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246581900047x · Cited by 13 · see citing works
Digital Psychotherapies for Adults Experiencing Depressive Symptoms: Systematic Review and Meta-Analysis
Omylinska‐Thurston, J., Aithal, S., Liverpool, S., Clark, R. D., Moula, Z., Wood, J., Viliardos, L., Rodríguez-Dorans, E., Farish-Edwards, F., Parsons, A. S., et al. (2024) · JMIR Mental Health · doi:10.2196/55500 · Cited by 14 · see citing works
Computer-assisted Cognitive Behavior Therapy and Mobile Apps for Depression and Anxiety: Evidence-based Digital Tools for Clinical Practice
Rajeshkumar, L., Mishkind, M., Coleman, J. J., Pahwa, M., LaPreze, D., Solenske, S., & Wright, J. H. (2024) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000815 · Cited by 7 · see citing works
Outcomes of a Program to Reduce Depression
Kim, G. H., Kim, K. H., & Park, H. (2010) · Western Journal of Nursing Research · doi:10.1177/0193945910386249 · Cited by 11 · see citing works
Dissemination of computer-assisted cognitive-behavior therapy for depression in primary care
Antle, B. F., Owen, J. J., Eells, T. D., Wells, M. J., Harris, L. M., Cappiccie, A., Wright, B., Williams, S. M., & Wright, J. H. (2018) · Contemporary Clinical Trials · doi:10.1016/j.cct.2018.11.001 · Cited by 10 · see citing works
Discrepancy in rating health-related quality of life of depression between patient and general population
Gerhards, S. A. H., Evers, S., Sabel, P. W. M., & Huibers, M. J. H. (2010) · Quality of Life Research · doi:10.1007/s11136-010-9746-x · Cited by 10 · see citing works
Self-citation
Cost-Effectiveness of Computer-Assisted Cognitive Behavioral Therapy for Depression Among Adults in Primary Care
Ali, S., Alemu, F. W., Owen, J. J., Eells, T. D., Antle, B. F., Lee, J. T., & Wright, J. H. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.44599 · Cited by 9 · see citing works
Internetbasierte Ansätze in der Therapie von Essstörungen
Fichter, M. M., Quadflieg, N., Nisslmüller, K., Lindner, S., Voderholzer, U., Wünsch‐Leiteritz, W., Osen, B., Huber, T., Zahn, S., Meermann, R., et al. (2011) · Der Nervenarzt · doi:10.1007/s00115-010-3228-9 · Cited by 9 · see citing works
Efficacy of an Internet-based Intervention Targeted to Adolescents with Subthreshold Depression
Makarushka, M. M. (2011) · Scholars' Bank (University of Oregon) · Cited by 9 · see citing works
Validation of the Attitudes Towards Psychological Online Interventions Questionnaire Among Black Americans: Cross-cultural Confirmatory Factor Analysis
Ellis, D. M., & Anderson, P. L. (2023) · JMIR Mental Health · doi:10.2196/43929 · Cited by 7 · see citing works
Perception of Mental Health Care Professionals in Saudi Arabia on Computerized Cognitive Behavioral Therapy: Observational Cross-sectional Study
AlHadi, A. N., Alammari, K. A., Alsiwat, L. J., Alhaidri, N. E., Alabdulkarim, N., Altwaijri, N. A., & AlSohaili, S. A. (2021) · JMIR Formative Research · doi:10.2196/26294 · Cited by 7 · see citing works
“In particular, cCBT provides substantial accessibility, scalability, and flexibility benefits over conventional one-on-one CBT, and has been suggested as an effective treatment [7,9-16], especially for low-intensity interventions [7,17].”
Background
Cognitive Behavioural Therapy and Cognitive Bias Modification in Internet-Based Interventions for Mood, Anxiety and Substance Use Disorders
Blankers, M., Salemink, E., & Wiers, R. (2016) · Springer eBooks · doi:10.1007/978-3-319-20852-7_10 · Cited by 6 · see citing works
“There is also some evidence regarding favourable cost-effectiveness of the guided version of Colour your life in comparison to a brief intervention provided by the general practitioner – although differences in effects were not found to be signifi cant [ 31 ].”
Background
Cost Utility Analysis of Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder: Randomized Controlled Trial
Zhou, W., Chen, Y., Wu, H., Zhao, H., Li, Y., Shi, G., Wang, W., Liu, Y., Liao, Y., Zhang, H., et al. (2024) · Journal of Medical Internet Research · doi:10.2196/67567 · Cited by 6 · see citing works
Reducing the Burden of Suicidal Thoughts through Online Cognitive Behavioural Therapy Self Help
Kerkhof, A. J. F. M., van Spijker, B. A. J., & Mokkenstorm, J. K. (2013) · Palgrave Macmillan UK eBooks · doi:10.1057/9781137351692_4 · Cited by 6 · see citing works
Facilitating Factors and Barriers to the Use of Emerging Technologies for Suicide Prevention in Europe: Multicountry Exploratory Study
Muñoz−Sánchez, J., Álvarez, C. D., Sánchez-Prada, A., Parra−Vidales, E., Leo, D. D., & Franco, M. (2018) · JMIR Mental Health · doi:10.2196/mental.7784 · Cited by 6 · see citing works
“In the area of mental health, the use of emerging technologies has proven effective in the treatment of different mental disorders [9,10], especially anxiety and depression [11,12].”
Background
Economic Evaluation of a Web Application Implemented in Primary Care for the Treatment of Depression in Patients With Type 2 Diabetes Mellitus: Multicenter Randomized Controlled Trial
Moreno, E. V., Ortiz, M. T. A., Sánchez, F. J., García‐Palacios, A., Monreal‐Bartolomé, A., Gili, M., García‐Campayo, J., & Mayoral, F. (2024) · JMIR mhealth and uhealth · doi:10.2196/55483 · Cited by 6 · see citing works
Internet-Delivered Psychotherapy for Anxiety Disorders and Depression
Titov, N., Dear, B. F., & Andersson, G. (2014) · Focus · doi:10.1176/appi.focus.12.3.299 · Cited by 5 · see citing works
A questionnaire-based qualitative study of therapist views on computerized CBT
Newton, J., & Sundin, E. (2016) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x16000131 · Cited by 5 · see citing works
“A few studies have used qualitative method to examine patients’ attitudes towards cCBT (e.g. Beattie et al. 2009; Gerhards et al. 2010).”
Method
‘Show me the money’: improving the economic evaluation of mental health services
Twomey, C. D., Byrne, M., & McHugh, P. (2013) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2013.41 · Cited by 5 · see citing works
Reducing the Burden of Suicidal Thoughts Through Online Self-Help
van Spijker, B. A. J. (2012) · Cited by 5 · see citing works
Internet-Delivered Cognitive Behavioral Therapy Tailored to Spouses and Significant Others of Public Safety Personnel: Formative Evaluation Study
Hadjistavropoulos, H. D., Reiser, S. J., Beahm, J. D., McCall, H. C., Dena, I., Phillips, A. R., Scheltgen, M., Sekhar, S., Cox, M., Cramm, H. A., et al. (2023) · JMIR Formative Research · doi:10.2196/51088 · Cited by 4 · see citing works
“Self-guided ICBT (ie, ICBT without a therapist) is particularly scalable [20] and cost-effective [21] and has demonstrated good outcomes for treating anxiety, depression [22], and PTSD [15], although therapist-guided ICBT tends to be somewhat more effective [23,24].”
Background
Internetbasierte Psychotherapie-Interventionen – Werden sich Patienten in Zukunft selbst therapieren?
Härpfer, K., & Bschor, T. (2017) · Nervenheilkunde · doi:10.1055/s-0038-1627033 · Cited by 4 · see citing works
Online Therapy for Adolescent Mental Health
Khan, H. A., Bernstein, K. S., & Voorhees, B. W. V. (2018) · Springer eBooks · doi:10.1007/978-3-319-69638-6_16 · Cited by 4 · see citing works
Electronic interventions for depression in adolescents: hot idea or hot air?
Bruce, V., & Kutcher, S. (2016) · South African Journal of Psychology · doi:10.1177/0081246316631434 · Cited by 5 · see citing works
“…interventions also may be available at lower cost than interventions that require the ongoing attendance of health or mental health professionals (Gerhards et al., 2010; Hollinghurst et al., 2010; Ruby, Marko-Holguin, Fogel, & Van Voorhees, 2013; Warmerdam, Smit, van Straten, Riper, & Cuijpers,…”
Background

Clinical effectiveness of online computerised cognitive–behavioural therapy without support for depression in primary care: randomised trial
de Graaf, L. E., Gerhards, S. A. H., Arntz, A., Riper, H., Metsemakers, J. F. M., Evers, S. M. A. A., Severens, J. L., Widdershoven, G., & Huibers, M. J. H. (2009) · British Journal of Psychiatry · doi:10.1192/bjp.bp.108.054429 · Cited by 190 · see citing works
Self-citation
Cost-effectiveness of therapist-delivered online cognitive–behavioural therapy for depression: randomised controlled trial
Hollinghurst, S., Peters, T. J., Kaur, S., Wiles, N., Lewisand, G., & Kessler, D. (2010) · British Journal of Psychiatry · doi:10.1192/bjp.bp.109.073080 · Cited by 123 · see citing works
Cost-effectiveness analysis of internet-mediated cognitive behavioural therapy for depression in the primary care setting: results based on a controlled trial
Holst, A., Björkelund, C., Metsini, A., Madsen, J.-H., Hange, D., Petersson, E., Eriksson, M. C. M., Kivi, M., Andersson, P.-Å., & Svensson, M. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019716 · Cited by 24 · see citing works
Clinical and cost-effectiveness of computerised cognitive behavioural therapy for depression in primary care: Design of a randomised trial
de Graaf, L. E., Gerhards, S. A. H., Evers, S., Arntz, A. R., Riper, H. M., Severens, J. L., Widdershoven, G. A. M., Metsemakers, J. F. M., & Huibers, M. J. H. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-224 · Cited by 38 · see citing works
Self-citation
Cost-Effectiveness of Computer-Assisted Cognitive Behavioral Therapy for Depression Among Adults in Primary Care
Ali, S., Alemu, F. W., Owen, J. J., Eells, T. D., Antle, B. F., Lee, J. T., & Wright, J. H. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.44599 · Cited by 9 · see citing works

Authors: Gerhards, S. A. H., de Graaf, L. E., Jacobs, L. E., Severens, J. L., Huibers, M. J. H., Arntz, A., Riper, H., Widdershoven, G., Metsemakers, J. F. M., & Evers, S. M. A. A.
Affiliations: Maastricht University (NL)
Trimbos Institute (NL)
Corresponding author: Gerhards, S. A. H.
ORCID: Severens, J. L.
Huibers, M. J. H.
Arntz, A.
Riper, H.
Widdershoven, G.
Evers, S. M. A. A.
Venue: British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 2010-04
Volume: 196
Issue: 4
Pages: 310-318
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/bjp.bp.109.065748
OpenAlex: W2138127123
Cited by: 135
References: 38
Citations by year: 2026: 1 · 2025: 1 · 2024: 8 · 2023: 3 · 2022: 9 · 2021: 4 · 2020: 9 · 2019: 7 · 2018: 6 · 2017: 7 · 2016: 7 · 2015: 12 · 2014: 20 · 2013: 10 · 2012: 12
FWCI: 19.56
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified, 2833 d)
Locations: The British Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Research Publications (Maastricht University) (publishedVersion, other-oa)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
VU Research Portal (publishedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Pure Amsterdam UMC (submittedVersion)
Research Publications (Maastricht University) (submittedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion)
Funders: ZonMw (945-04-417)
Care and Public Health Research Institute, Universiteit Maastricht
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 › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: computerized cognitive behavioral therapy, depression, cost-effectiveness, cost-utility analysis, primary care, online therapy, usual care, quality of life, depression severity, medication adherence
MeSH terms: Adolescent, Adult, Aged, Cost-Benefit Analysis, Depressive Disorder, Humans, Middle Aged, Netherlands, Primary Health Care, Psychiatric Status Rating Scales, Quality of Life, Sensitivity and Specificity, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Health Care Costs, Cost of Illness, Young Adult

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Economic evaluation of online computerised cognitive-behavioural therapy without support for depression in primary care: Randomised trial

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