Cost-effectiveness of cognitive-behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: economic evaluation of the CoBalT Trial

Br J Psychiatry. 2014 Jan;204(1):69-76. doi: 10.1192/bjp.bp.112.125286. Epub 2013 Nov 21.


Background: Depression is expensive to treat, but providing ineffective treatment is more expensive. Such is the case for many patients who do not respond to antidepressant medication.

Aims: To assess the cost-effectiveness of cognitive-behavioural therapy (CBT) plus usual care for primary care patients with treatment-resistant depression compared with usual care alone.

Method: Economic evaluation at 12 months alongside a randomised controlled trial. Cost-effectiveness assessed using a cost-consequences framework comparing cost to the health and social care provider, patients and society, with a range of outcomes. Cost-utility analysis comparing health and social care costs with quality-adjusted life-years (QALYs).

Results: The mean cost of CBT per participant was £910. The difference in QALY gain between the groups was 0.057, equivalent to 21 days a year of good health. The incremental cost-effectiveness ratio was £14 911 (representing a 74% probability of the intervention being cost-effective at the National Institute of Health and Care Excellence threshold of £20 000 per QALY). Loss of earnings and productivity costs were substantial but there was no evidence of a difference between intervention and control groups.

Conclusions: The addition of CBT to usual care is cost-effective in patients who have not responded to antidepressants. Primary care physicians should therefore be encouraged to refer such individuals for CBT.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antidepressive Agents / economics*
  • Antidepressive Agents / therapeutic use
  • Cognitive Behavioral Therapy / economics*
  • Combined Modality Therapy / economics
  • Cost of Illness*
  • Cost-Benefit Analysis
  • Depressive Disorder, Treatment-Resistant / economics
  • Depressive Disorder, Treatment-Resistant / therapy*
  • England
  • Female
  • Health Services Needs and Demand
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / economics
  • Outcome Assessment, Health Care / statistics & numerical data
  • Practice Guidelines as Topic
  • Primary Health Care / economics*
  • Primary Health Care / methods
  • Quality-Adjusted Life Years
  • Young Adult


  • Antidepressive Agents