Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial

Wiles, Nicola; Thomas, Laura; Abel, Anna; Barnes, Maria; Carroll, Fran; Ridgway, Nicola; Sherlock, Sofie; Turner, Nicholas; Button, Katherine S; Odondi, Lang’o; Metcalfe, Chris; Owen-Smith, Amanda; Campbell, John; Garland, Anne; Hollinghurst, Sandra; Jerrom, Bill; Keßler, David; Kuyken, Willem; Morrison, Jill; Turner, Katrina; Williams, Chris; Peters, Tim J.

doi:10.3310/hta18310

Cited by 80 publications

(74 citation statements)

References 169 publications

(297 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One of these studies was their pilot study and the other two trials were conducted with very small sample sizes. 752 Although this lack of substantial change from the earlier systematic review meant that no-one was interested in publishing the Bristol team's updated systematic review, it did help strengthen their application for the HTA grant (interviewee).…”

Section: Stage 0: Topic/issue Identificationmentioning

confidence: 99%

“…Across the three sites, 73 GP practices were involved in recruiting 469 patients for the trial. 752 This study was hugely collaborative and required excellent communication and organisation (interviewee). The actual team members at each site and their contributions to the study are listed above (see Interface A: Project specification and selection, above).…”

Section: Stage 1: Inputs To Researchmentioning

confidence: 99%

“…In total, 73 general practices agreed to take part in the study. 752 Each of the recruited practices searched their records for patients who had TRD. For this study TRD was defined as 'those who have significant depressive symptoms following at least 6 weeks' treatment with antidepressant medication at an adequate dose'.…”

Section: Stage 2: Research Processmentioning

confidence: 99%

“…Other data that were collected at 6 and 12 months included information on health and social care use, personal expenditure on private treatments, and time off work. 752 For the cost-effectiveness component of this trial, cost-consequence analyses were reported from the health and social care, patient and lost productivity perspectives. In addition to this a cost-utility analysis compared health and social care costs with QALYs.…”

Section: Stage 2: Research Processmentioning

confidence: 99%

See 3 more Smart Citations

The impact of the National Institute for Health Research Health Technology Assessment programme, 2003–13: a multimethod evaluation

Guthrie

Bienkowska-Gibbs

Manville

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

BackgroundThe National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme supports research tailored to the needs of NHS decision-makers, patients and clinicians. This study reviewed the impact of the programme, from 2003 to 2013, on health, clinical practice, health policy, the economy and academia. It also considered how HTA could maintain and increase its impact.MethodsInterviews (n = 20): senior stakeholders from academia, policy-making organisations and the HTA programme. Bibliometric analysis: citation analysis of publications arising from HTA programme-funded research. Researchfish survey: electronic survey of all HTA grant holders. Payback case studies (n = 12): in-depth case studies of HTA programme-funded research.ResultsWe make the following observations about the impact, and routes to impact, of the HTA programme: it has had an impact on patients, primarily through changes in guidelines, but also directly (e.g. changing clinical practice); it has had an impact on UK health policy, through providing high-quality scientific evidence – its close relationships with the National Institute for Health and Care Excellence (NICE) and the National Screening Committee (NSC) contributed to the observed impact on health policy, although in some instances other organisations may better facilitate impact; HTA research is used outside the UK by other HTA organisations and systematic reviewers – the programme has an impact on HTA practice internationally as a leader in HTA research methods and the funding of HTA research; the work of the programme is of high academic quality – theHealth Technology Assessmentjournal ensures that the vast majority of HTA programme-funded research is published in full, while the HTA programme still encourages publication in other peer-reviewed journals; academics agree that the programme has played an important role in building and retaining HTA research capacity in the UK; the HTA programme has played a role in increasing the focus on effectiveness and cost-effectiveness in medicine – it has also contributed to increasingly positive attitudes towards HTA research both within the research community and the NHS; and the HTA focuses resources on research that is of value to patients and the UK NHS, which would not otherwise be funded (e.g. where there is no commercial incentive to undertake research). The programme should consider the following to maintain and increase its impact: providing targeted support for dissemination, focusing resources when important results are unlikely to be implemented by other stakeholders, particularly when findings challenge vested interests; maintaining close relationships with NICE and the NSC, but also considering other potential users of HTA research; maintaining flexibility and good relationships with researchers, giving particular consideration to the Technology Assessment Report (TAR) programme and the potential for learning between TAR centres; maintaining the academic quality of the work and the focus on NHS need; considering funding research on the short-term costs of the implementation of new health technologies; improving the monitoring and evaluation of whether or not patient and public involvement influences research; improve the transparency of the priority-setting process; and continuing to monitor the impact and value of the programme to inform its future scientific and administrative development.FundingThe NIHR HTA programme.

show abstract

Section: Stage 0: Topic/issue Identificationmentioning

confidence: 99%

Section: Stage 1: Inputs To Researchmentioning

confidence: 99%

Section: Stage 2: Research Processmentioning

confidence: 99%

Section: Stage 2: Research Processmentioning

confidence: 99%

See 2 more Smart Citations

The impact of the National Institute for Health Research Health Technology Assessment programme, 2003–13: a multimethod evaluation

Guthrie

Bienkowska-Gibbs

Manville

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…To date, there are limited evidence-based therapeutic options for a TRBD patient who fails to respond to ECT. Although cognitive-behavioral therapy (CBT) in combination with pharmacotherapy is efficacious for TRD [3], there is limited literature on its role in TRBD patients who fail to respond to ECT. Here we report a case of a TRBD patient achieving functional recovery with CBT in combination with pharmacotherapy after failing to respond to a course of ECT.…”

Section: Treatment-resistant Bipolar Depression/electroconvulsive Thementioning

confidence: 99%

When electroconvulsive therapy fails: cognitive– behavioral therapy in treatment-resistant bipolar depression. A case report

Loo

Samad

Sidi³

et al. 2016

Arch Psych Psych

View full text Add to dashboard Cite

show abstract

Psychological therapies for treatment-resistant depression in adults

Ijaz

Davies

Williams

et al. 2018

Cochrane Database of Systematic Reviews

Self Cite

View full text Add to dashboard Cite

Background Antidepressants are a first-line treatment for adults with moderate to severe major depression. However, many people prescribed antidepressants for depression don't respond fully to such medication, and little evidence is available to inform the most appropriate 'next step' treatment for such patients, who may be referred to as having treatment-resistant depression (TRD). National Institute for 1. Any psychological therapy versus antidepressant treatment alone, or another psychological therapy. 2. Any psychological therapy given in addition to antidepressant medication versus antidepressant treatment alone, or a psychological therapy alone. Primary outcomes required were change in depressive symptoms and number of dropouts from study or treatment (as a measure of acceptability). Data collection and analysis We extracted data, assessed risk of bias in duplicate, and resolved disagreements through discussion or consultation with a third person. We conducted random-effects meta-analyses when appropriate. We summarised continuous outcomes using mean differences (MDs) or standardised mean differences (SMDs), and dichotomous outcomes using risk ratios (RRs). Main results We included six trials (n = 698; most participants were women approximately 40 years of age). All studies evaluated psychotherapy plus usual care (with antidepressants) versus usual care (with antidepressants). Three studies addressed the addition of cognitivebehavioural therapy (CBT) to usual care (n = 522), and one each evaluated intensive short-term dynamic psychotherapy (ISTDP) (n = 60), interpersonal therapy (IPT) (n = 34), or group dialectical behavioural therapy (DBT) (n = 19) as the intervention. Most studies were small (except one trial of CBT was large), and all studies were at high risk of detection bias for the main outcome of self-reported depressive symptoms. A random-effects meta-analysis of five trials (n = 575) showed that psychotherapy given in addition to usual care (vs usual care alone) produced improvement in self-reported depressive symptoms (MD-4.07 points, 95% confidence interval (CI)-7.07 to-1.07 on the Beck Depression Inventory (BDI) scale) over the short term (up to six months). Effects were similar when data from all six studies were combined for self-reported depressive symptoms (SMD-0.40, 95% CI-0.65 to-0.14; n = 635). The quality of this evidence was moderate. Similar moderate-quality evidence of benefit was seen on the Patient Health Questionnaire-9 Scale (PHQ-9) from two studies (MD-4.66, 95% CI 8.72 to-0.59; n = 482) and on the Hamilton Depression Rating Scale (HAMD) from four studies (MD-3.28, 95% CI-5.71 to-0.85; n = 193). High-quality evidence shows no differential dropout (a measure of acceptability) between intervention and comparator groups over the short term (RR 0.85, 95% CI 0.58 to 1.24; six studies; n = 698). Moderate-quality evidence for remission from six studies (RR 1.92, 95% CI 1.46 to 2.52; n = 635) and low-quality evidence for response from four studies (RR 1.80, 95% CI 1.2 to 2.7; n = 556) i...

show abstract

Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial

Cited by 80 publications

References 169 publications

The impact of the National Institute for Health Research Health Technology Assessment programme, 2003–13: a multimethod evaluation

The impact of the National Institute for Health Research Health Technology Assessment programme, 2003–13: a multimethod evaluation

When electroconvulsive therapy fails: cognitive– behavioral therapy in treatment-resistant bipolar depression. A case report

Psychological therapies for treatment-resistant depression in adults

Contact Info

Product

Resources

About