Authors' objectives: This health technology assessment looked at the effectiveness, safety, cost-effectiveness, budget impact of publicly funding, and patient preferences and values associated with internet-delivered cognitive behavioural therapy (iCBT) for the treatment of mild to moderate major depression and anxiety disorders.

Authors' results and conclusions: Compared with waiting list, guided iCBT improves symptoms of mild to moderate major depression and select anxiety disorders. Guided iCBT represents the most economical option for the short-term treatment of adults with mild to moderate major depression or anxiety disorders. Over the next 5 years, we estimate that publicly funding guided iCBT will result in additional annual costs of between $10 million and $40 million for mild to moderate major depression and between $16 million and $65 million for anxiety disorders. People with anxiety or depression with whom we spoke viewed iCBT as an effective treatment option. Internet-delivered CBT may be especially beneficial for those whose symptoms may prevent them from leaving home. However, participants reported important barriers and limitations to using iCBT, including the need for a computer, internet access, and computer literacy, as well as the ability to understand complex written information. Participants found that the cost of treatment, the number of sessions in a course of treatment, and the lack of follow-up support were also substantial drawbacks for iCBT.

Authors' recommendations: Health Quality Ontario, under the guidance of the Ontario Health Technology Advisory Committee, recommends publicly funding guided internet-delivered cognitive behavioural therapy for mild to moderate major depression and anxiety disorders

Authors' methods: We conducted a health technology assessment, which included an evaluation of clinical benefit, value for money, and patient preferences and values related to the use of iCBT for the treatment of mild to moderate major depression or anxiety disorders. We performed a systematic review of the clinical and economic literature and conducted a grey literature search. We reported Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ratings if sufficient information was provided. When other quality assessment tools were used by the systematic review authors in the included studies, these were reported. We assessed the risk of bias within the included reviews. We also developed decision-analytic models to compare the costs and benefits of unguided iCBT, guided iCBT, face-to-face CBT, and usual care over 1 year using a sequential approach. We further explored the lifetime and short-term cost-effectiveness of stepped-care models, including iCBT, compared with usual care. We calculated incremental cost-effectiveness ratios (ICERs) from the perspective of the Ontario Ministry of Health and Long-Term Care and estimated the 5-year budget impact of publicly funding iCBT for mild to moderate major depression or anxiety disorders in Ontario. To contextualize the potential value of iCBT as a treatment option for major depression or anxiety disorders, we spoke with people with these conditions.

Project Status: Completed

Year Published: 2019

URL for published report: https://www.hqontario.ca/evidence-to-improve-care/health-technology-assessment/reviews-and-recommendations/internet-delivered-cognitive-behavioural-therapy-for-major-depression-and-anxiety-disorders

Requestor: Ontario Health Technology Advisory Committee (OHTAC); Ontario Ministry of Health

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Ontario

Pubmed ID: 30873251

Organisation Name: Health Quality Ontario

Contact Address: Evidence Development and Standards, Health Quality Ontario, 130 Bloor Street West, 10th floor, Toronto, Ontario Canada M5S 1N5

Contact Name: EDSinfo@hqontario.ca

Contact Email: OH-HQO_hta-reg@ontariohealth.ca

Copyright: Health Quality Ontario