Original Title: Brugen af guidet, internetbaseret kognitiv adfærdsterapi til behandling af voksne med let eller moderat depression

Authors' objectives: In Denmark, there are several different treatment options for patients with mild or moderate depression. This study assesses whether guided internet based cognitive behavior therapy (iCBT) should be used as treatment for adults with mild or moderate depression rather than cognitive behavioral therapy with a therapist or ‘talk therapy’ with a general practitioner.

Authors' results and conclusions: The assessment examines the clinical effectiveness and safety of guided iCBT compared to standard depression treatments in Denmark. Nine relevant studies were identified, but their evidence quality ranged from low to very low. Meta-analyses revealed no systematic differences between guided iCBT and therapy with a general practitioner, nor between guided iCBT and CBT with a trained therapist. The expert committee has limited confidence in the findings due to the sparse evidence base and low quality of included studies. Consequently, the expert committee does not find it feasible to definitively assess differences in effectiveness between these interventions. Further research may be necessary to strengthen the evidence and draw clearer conclusions. The patient perspective explores various factors related to adherence that help patients start and complete treatment with guided iCBT. Key themes that discourage individuals from choosing or initiating guided iCBT include program rigidity, technical difficulties, understanding of information and content, financial costs, and IT skill requirements. Studies find that a therapeutic alliance can emerge in iCBT similar to traditional CBT. The quality of this alliance and individual preferences significantly influence treatment outcomes and patient experiences. The expert committee concludes that guided iCBT is a beneficial option for those who prefer self-reliant, flexible, and anonymous treatment. However, they emphasize that guided iCBT should not be the only treatment option available to patients. The organizational perspective examines various subjects regarding ICBT. To offer ICBT, an online platform and professional content are required. There are pros and cons associated with either purchasing or developing both. It often requires staff adaptation to work with ICBT, and the organization must prevent therapists from experiencing 'digital burnout.' The report also uncovers implications of treatment without prior referral. Studies show that self-referred and doctor-referred patients often have similar depression symptoms, and the option for self-referral increases participation from certain population groups. Therefore, self-referral can be a viable option to enhance the accessibility of treatment services. The health economic perspective examines cost differences between guided iCBT and CBT, as well as the budgetary consequences of implementing guided iCBT nationally. The results show that iCBT costs DKK 8,223, counseling by a general practitioner costs 4,673 DKK, and CBT costs DKK 11,271. Patient time spent on treatment is a highly uncertain parameter that can significantly impact the final health economic outcome. Additionally, the patient's co-payment for CBT, at DKK 3,477, can affect the results. The budget impact analysis indicates a national budgetary impact of DKK 96.3 million. The committee does not expect the implementation of guided iCBT to alter the demand for CBT and counseling by general practitioners. They emphasize that, even with scaling up, the value for money remains unclear, as highlighted by the Clinical Effect and Safety results

Project Status: Completed

URL for project: https://behandlingsraadet.dk/find-evalueringer-analyser/analyser/2022/guidet-internetbaseret-kognitiv-adfaerdsterapi-til-behandling-af-voksne-med-let-eller-moderat-depression

Year Published: 2024

URL for published report: https://behandlingsraadet-classic.azureedge.net/media/yvjh55sn/recommendation.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Denmark

Organisation Name: The Danish Health Technology Council

Contact Address: Niels Jernes Vej 6a, 9220 Aalborg

Contact Name: Nikolaj Hellmuth Skak

Contact Email: nsp@behandlingsraadet.dk