Cost-effectiveness of twice-weekly versus once-weekly sessions of cognitive-behavioural therapy and interpersonal psychotherapy for depression at 12 months after start of treatment: randomised controlled trial

J.E. Bosmans; S.J.E. Bruijniks; M. El Alili; S.D. Hollon; F.P.M.L. Peeters; A. Arntz; P. Cuijpers; L.H.J.M. Lemmens; P. Dingemanse; L. Willems; P. van Oppen; M. van den Boogaard; J. Spijker; J.W.R. Twisk; M.J.H. Huibers

doi:10.1192/bjo.2023.548

Cost-effectiveness of twice-weekly versus once-weekly sessions of cognitive-behavioural therapy and interpersonal psychotherapy for depression at 12 months after start of treatment: randomised controlled trial

J.E. Bosmans^*, S.J.E. Bruijniks, M. El Alili, S.D. Hollon, F.P.M.L. Peeters, A. Arntz, P. Cuijpers, L.H.J.M. Lemmens, P. Dingemanse, L. Willems, P. van Oppen, M. van den Boogaard, J. Spijker, J.W.R. Twisk, M.J.H. Huibers

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Cost-effective treatments are needed to reduce the burden of depression. One way to improve the cost-effectiveness of psychotherapy might be to increase session frequency, but keep the total number of sessions constant.

AIM: To evaluate the cost-effectiveness of twice-weekly compared with once-weekly psychotherapy sessions after 12 months, from a societal perspective.

METHOD: An economic evaluation was conducted alongside a randomised controlled trial comparing twice-weekly versus once-weekly sessions of psychotherapy (cognitive-behavioural therapy or interpersonal psychotherapy) for depression. Missing data were handled by multiple imputation. Statistical uncertainty was estimated with bootstrapping and presented with cost-effectiveness acceptability curves.

RESULTS: Differences between the two groups in depressive symptoms, physical and social functioning, and quality-adjusted life-years (QALY) at 12-month follow-up were small and not statistically significant. Total societal costs in the twice-weekly session group were higher, albeit not statistically significantly so, than in the once-weekly session group (mean difference €2065, 95% CI -686 to 5146). The probability that twice-weekly sessions are cost-effective compared with once-weekly sessions was 0.40 at a ceiling ratio of €1000 per point improvement in Beck Depression Inventory-II score, 0.32 at a ceiling ratio of €50 000 per QALY gained, 0.23 at a ceiling ratio of €1000 per point improvement in physical functioning score and 0.62 at a ceiling ratio of €1000 per point improvement in social functioning score.

CONCLUSIONS: Based on the current results, twice-weekly sessions of psychotherapy for depression are not cost-effective over the long term compared with once-weekly sessions.

Original language	English
Article number	e186
Pages (from-to)	1-7
Number of pages	7
Journal	BJPsych Open
Volume	9
Issue number	6
DOIs	https://doi.org/10.1192/bjo.2023.548
Publication status	Published - 13 Oct 2023

Bibliographical note

Publisher Copyright:
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

Funding

This study was funded by ZonMw and Stichting tot Steun Vereniging tot Christelijke Verzorging. The funders were not involved in the study design; the collection, analysis and interpretation of data; the writing of the report or the decision to submit the article for publication.

Funders	Funder number
ZonMw

Keywords

Depressive disorders
cost-effectiveness
individual psychotherapy
out-patient treatment
randomised controlled trial

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Bosmans, J. E., Bruijniks, S. J. E., El Alili, M., Hollon, S. D., Peeters, F. P. M. L., Arntz, A., Cuijpers, P., Lemmens, L. H. J. M., Dingemanse, P., Willems, L., van Oppen, P., van den Boogaard, M., Spijker, J., Twisk, J. W. R., & Huibers, M. J. H. (2023). Cost-effectiveness of twice-weekly versus once-weekly sessions of cognitive-behavioural therapy and interpersonal psychotherapy for depression at 12 months after start of treatment: randomised controlled trial. BJPsych Open, 9(6), 1-7. Article e186. https://doi.org/10.1192/bjo.2023.548

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title = "Cost-effectiveness of twice-weekly versus once-weekly sessions of cognitive-behavioural therapy and interpersonal psychotherapy for depression at 12 months after start of treatment: randomised controlled trial",

abstract = "BACKGROUND: Cost-effective treatments are needed to reduce the burden of depression. One way to improve the cost-effectiveness of psychotherapy might be to increase session frequency, but keep the total number of sessions constant.AIM: To evaluate the cost-effectiveness of twice-weekly compared with once-weekly psychotherapy sessions after 12 months, from a societal perspective.METHOD: An economic evaluation was conducted alongside a randomised controlled trial comparing twice-weekly versus once-weekly sessions of psychotherapy (cognitive-behavioural therapy or interpersonal psychotherapy) for depression. Missing data were handled by multiple imputation. Statistical uncertainty was estimated with bootstrapping and presented with cost-effectiveness acceptability curves.RESULTS: Differences between the two groups in depressive symptoms, physical and social functioning, and quality-adjusted life-years (QALY) at 12-month follow-up were small and not statistically significant. Total societal costs in the twice-weekly session group were higher, albeit not statistically significantly so, than in the once-weekly session group (mean difference €2065, 95% CI -686 to 5146). The probability that twice-weekly sessions are cost-effective compared with once-weekly sessions was 0.40 at a ceiling ratio of €1000 per point improvement in Beck Depression Inventory-II score, 0.32 at a ceiling ratio of €50 000 per QALY gained, 0.23 at a ceiling ratio of €1000 per point improvement in physical functioning score and 0.62 at a ceiling ratio of €1000 per point improvement in social functioning score.CONCLUSIONS: Based on the current results, twice-weekly sessions of psychotherapy for depression are not cost-effective over the long term compared with once-weekly sessions.",

keywords = "Depressive disorders, cost-effectiveness, individual psychotherapy, out-patient treatment, randomised controlled trial",

author = "J.E. Bosmans and S.J.E. Bruijniks and {El Alili}, M. and S.D. Hollon and F.P.M.L. Peeters and A. Arntz and P. Cuijpers and L.H.J.M. Lemmens and P. Dingemanse and L. Willems and {van Oppen}, P. and {van den Boogaard}, M. and J. Spijker and J.W.R. Twisk and M.J.H. Huibers",

note = "Publisher Copyright: Copyright {\textcopyright} The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.",

year = "2023",

month = oct,

day = "13",

doi = "10.1192/bjo.2023.548",

language = "English",

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Bosmans, JE, Bruijniks, SJE, El Alili, M, Hollon, SD, Peeters, FPML, Arntz, A, Cuijpers, P, Lemmens, LHJM, Dingemanse, P, Willems, L, van Oppen, P, van den Boogaard, M, Spijker, J, Twisk, JWR & Huibers, MJH 2023, 'Cost-effectiveness of twice-weekly versus once-weekly sessions of cognitive-behavioural therapy and interpersonal psychotherapy for depression at 12 months after start of treatment: randomised controlled trial', BJPsych Open, vol. 9, no. 6, e186, pp. 1-7. https://doi.org/10.1192/bjo.2023.548

Cost-effectiveness of twice-weekly versus once-weekly sessions of cognitive-behavioural therapy and interpersonal psychotherapy for depression at 12 months after start of treatment: randomised controlled trial. / Bosmans, J.E.; Bruijniks, S.J.E.; El Alili, M. et al.
In: BJPsych Open, Vol. 9, No. 6, e186, 13.10.2023, p. 1-7.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Cost-effectiveness of twice-weekly versus once-weekly sessions of cognitive-behavioural therapy and interpersonal psychotherapy for depression at 12 months after start of treatment

T2 - randomised controlled trial

AU - Bosmans, J.E.

AU - Bruijniks, S.J.E.

AU - El Alili, M.

AU - Hollon, S.D.

AU - Peeters, F.P.M.L.

AU - Arntz, A.

AU - Cuijpers, P.

AU - Lemmens, L.H.J.M.

AU - Dingemanse, P.

AU - Willems, L.

AU - van Oppen, P.

AU - van den Boogaard, M.

AU - Spijker, J.

AU - Twisk, J.W.R.

AU - Huibers, M.J.H.

PY - 2023/10/13

Y1 - 2023/10/13

N2 - BACKGROUND: Cost-effective treatments are needed to reduce the burden of depression. One way to improve the cost-effectiveness of psychotherapy might be to increase session frequency, but keep the total number of sessions constant.AIM: To evaluate the cost-effectiveness of twice-weekly compared with once-weekly psychotherapy sessions after 12 months, from a societal perspective.METHOD: An economic evaluation was conducted alongside a randomised controlled trial comparing twice-weekly versus once-weekly sessions of psychotherapy (cognitive-behavioural therapy or interpersonal psychotherapy) for depression. Missing data were handled by multiple imputation. Statistical uncertainty was estimated with bootstrapping and presented with cost-effectiveness acceptability curves.RESULTS: Differences between the two groups in depressive symptoms, physical and social functioning, and quality-adjusted life-years (QALY) at 12-month follow-up were small and not statistically significant. Total societal costs in the twice-weekly session group were higher, albeit not statistically significantly so, than in the once-weekly session group (mean difference €2065, 95% CI -686 to 5146). The probability that twice-weekly sessions are cost-effective compared with once-weekly sessions was 0.40 at a ceiling ratio of €1000 per point improvement in Beck Depression Inventory-II score, 0.32 at a ceiling ratio of €50 000 per QALY gained, 0.23 at a ceiling ratio of €1000 per point improvement in physical functioning score and 0.62 at a ceiling ratio of €1000 per point improvement in social functioning score.CONCLUSIONS: Based on the current results, twice-weekly sessions of psychotherapy for depression are not cost-effective over the long term compared with once-weekly sessions.

AB - BACKGROUND: Cost-effective treatments are needed to reduce the burden of depression. One way to improve the cost-effectiveness of psychotherapy might be to increase session frequency, but keep the total number of sessions constant.AIM: To evaluate the cost-effectiveness of twice-weekly compared with once-weekly psychotherapy sessions after 12 months, from a societal perspective.METHOD: An economic evaluation was conducted alongside a randomised controlled trial comparing twice-weekly versus once-weekly sessions of psychotherapy (cognitive-behavioural therapy or interpersonal psychotherapy) for depression. Missing data were handled by multiple imputation. Statistical uncertainty was estimated with bootstrapping and presented with cost-effectiveness acceptability curves.RESULTS: Differences between the two groups in depressive symptoms, physical and social functioning, and quality-adjusted life-years (QALY) at 12-month follow-up were small and not statistically significant. Total societal costs in the twice-weekly session group were higher, albeit not statistically significantly so, than in the once-weekly session group (mean difference €2065, 95% CI -686 to 5146). The probability that twice-weekly sessions are cost-effective compared with once-weekly sessions was 0.40 at a ceiling ratio of €1000 per point improvement in Beck Depression Inventory-II score, 0.32 at a ceiling ratio of €50 000 per QALY gained, 0.23 at a ceiling ratio of €1000 per point improvement in physical functioning score and 0.62 at a ceiling ratio of €1000 per point improvement in social functioning score.CONCLUSIONS: Based on the current results, twice-weekly sessions of psychotherapy for depression are not cost-effective over the long term compared with once-weekly sessions.

KW - Depressive disorders

KW - cost-effectiveness

KW - individual psychotherapy

KW - out-patient treatment

KW - randomised controlled trial

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Cost-effectiveness of twice-weekly versus once-weekly sessions of cognitive-behavioural therapy and interpersonal psychotherapy for depression at 12 months after start of treatment: randomised controlled trial

Abstract

Bibliographical note

Funding

Keywords

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