BMJ 2000;321:1389-1392 ( 2 December )

General Practice

Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. II: Cost effectiveness

Editorial by Briggs

Peter Bower, research fellow, ^a Sarah Byford, research fellow, ^b Bonnie Sibbald, professor, ^a Elaine Ward, research fellow, ^c Michael King, head, ^c Margaret Lloyd, reader, ^c Mark Gabbay, senior lecturer. ^d

^a National Primary Care Research and Development Centre (NPCRDC), University of Manchester, ^b Centre for Health Economics, York University, York YO10 5DD, ^c Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, University College London, London NW3 2PF, ^d Department of Primary Care, University of Liverpool

Correspondence to: M King m.king{at}rfc.ucl.ac.uk

Objective: To compare the cost effectiveness of general practitioner care and two general practice based psychological therapies for depressed patients.
Design: Prospective, controlled trial with randomised and patient preference allocation arms.
Setting: General practices in London and greater Manchester.
Participants: 464 of 627 patients presenting with depression or mixed anxiety and depression were suitable for inclusion.
Interventions: Usual general practitioner care or up to 12 sessions of non-directive counselling or cognitive-behaviour therapy provided by therapists.
Main outcome measures: Beck depression inventory scores, EuroQol measure of health related quality of life, direct treatment and non-treatment costs, and cost of lost production.
Results: 197 patients were randomly assigned to treatment, 137 chose their treatment, and 130 were randomised only between the two psychological therapies. At four months, both non-directive counselling and cognitive-behaviour therapy reduced depressive symptoms to a significantly greater extent than usual general practitioner care. There was no significant difference in outcome between treatments at 12 months. There were no significant differences in direct costs, production losses, or societal costs between the three treatments at either four or 12 months. Sensitivity analyses did not suggest that the results depended on particular assumptions in the statistical analysis.
Conclusions: Within the constraints of available power, the data suggest that both brief psychological therapies may be significantly more cost effective than usual care in the short term, as benefit was gained with no significant difference in cost. There are no significant differences between treatments in either outcomes or costs at 12 months.

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Health service perspective should not be lost

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Usual GP care

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