Improving Cost-effectiveness and Access to Cognitive Behavior Therapy for Depression: Providing Remote-Ready, Computer-Assisted Psychotherapy in Times of Crisis and Beyond

Abstract

Introduction: There is growing evidence that computer-delivered or computer-assisted forms of cognitive behavior therapy (CCBT) are helpful, but cost-effectiveness versus standard therapies is not well established. Objective: To evaluate the cost-effectiveness of a therapist-supported method for CCBT in comparison to standard cognitive behavior therapy (CBT). Methods: A total of 154 drug-free major depressive disorder outpatients were randomly assigned to either 16 weeks of standard CBT (up to twenty 50-min sessions) or CCBT using the Good Days Ahead program (including up to 5.5 h of therapist contact). Outcomes were assessed at baseline, weeks 8 and 16, and at 3 and 6 months posttreatment. Economic analyses took into account the costs of services received and work/social role impairment. Results: In the context of almost identical efficacy, a form of CCBT that used only about one third the amount of therapist contact as conventional CBT was highly cost-effective compared to conventional therapy and reduced the adjusted cost of treatment by USD 945 per patient. Conclusions: A method of CCBT that blended internet-delivered modules and abbreviated therapeutic contact reduced the cost of treatment substantially without adversely affecting outcomes. Results suggest that use of this approach can more than double the access to CBT. Because clinician support in CCBT can be provided by telephone, videoconference, and/or email, this highly efficient form of treatment could be a major advance in remote treatment delivery.

Twelve-Month Follow-Up to a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention for Rural Adults With Depression Symptoms: Single-Arm Longitudinal Study

“…To our knowledge, this study is the first to demonstrate both short- and long-term positive impacts of a self-guided iCBT intervention on depression and anxiety symptoms, work and social functioning, and resilience among rural adults in the United States. iCBT interventions, such as Thrive, have the potential to provide help and clinical benefit to people with substantial barriers to traditional forms of care; they also present a cost-effective alternative [ 41 ] with additional benefits of confidentiality that may not be possible for those seeking traditional care in small rural communities. That iCBT interventions have the potential for greater accessibility, privacy, and affordability in many rural areas compared to in-person psychological treatment is particularly encouraging.…”

A Call for Addressing Barriers to Telemedicine: Health Disparities during the COVID-19 Pandemic

“…Notwithstanding that it appears promising to make the most of telemedicine (through videoconference, tele-phone, e-mail, text, or apps) in responding to disasters and public health emergencies such as the COVID-19 pandemic [2], there are challenges to deliver timely care to individuals having pressing mental health needs at a distance. First, many individuals encounter barriers to telemedicine due to low socioeconomic status (SES) and the limitation of infrastructure among the least developing countries [3].…”

Digital Interventions for Psychological Comorbidities in Chronic Diseases—A Systematic Review

“…Results from this review also suggest that treatment efficacy on psychological comorbidities can be reached even with the implementation of minimum technological requirements (i.e., phone-based psychological treatments). Also recent studies evidenced that a remote psychological treatment (CBT) aimed at reducing depression and anxiety symptoms in adults with depressive symptoms, delivered by phone, was as effective as the same treatment administered face-to-face [ 72 , 73 , 74 , 75 , 76 ]. Concerning the design of the digital content, this work shows that interventions based on the administration of digital contents are effective when they are designed to target the specific chronic disease treated.…”