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Background: patients suffering from depression, and phobias are treated within the care setting, although many patients not seek help or their condition is not recognised healthcare professionals. Medication usually the first treatment offered but this often associated with side-effects. There is evidence to support the use of cognitive therapy (CBT) in the treatment these disorders. However, access is limited to too few therapists, expense, waiting lists, patients’ reluctance to enter therapy. Computerised behaviour therapy (CCBT) a self-help option that offers patients the benefits of CBT with less involvement.: overall aim of the review was to assess clinical effectiveness of CCBT for treating, depression and phobias and to compare cost-effectiveness of CCBT with CBT by methods and with treatment usual (TAU).: systematic review of the literature was performed identify all studies describing trials CCBT either delivered alone or as part of a and either via a computer interface over the telephone with a computer-led. Databases were searched from 1966 to September 2001. cost-effectiveness review was divided into parts: the economic evidence on CCBT was, and a modelling exercise was undertaken the aim of estimating the cost per of providing CCBT and the number of that could be treated. An attempt was made to estimate the effect of CCBT in of quality-adjusted life-years (QALYs).: and quality of studies: studies met the inclusion criteria. Of, 11 were randomised controlled trials (RCTs) and five were pilot studies or cohort. The quality of the studies ranged from to moderate. An additional three studies identified that dealt with the use of CCBT a treatment adjunct for therapist-led (TCBT). papers were identified for the -effectiveness review although none dealt with CCBT. Four sponsor submissions used in the cost-effectiveness analysis Ultrasis (Beating the Blues), Leeds (Calipso), University of Glasgow (Stresspac) and ST Solutions (FearFighter Cope). effectiveness: results can be summarised as follows. • There is some evidence of poor-to-moderate that CCBT is as effective as TCBT in depressed, anxious or phobic and primary care populations. • There is limited evidence of poor-to-moderate that CCBT is more effective than TAU clinically depressed, anxious or phobic and primary care populations. • CCBT may be as effective or less effective bibliotherapy. There is no evidence that is more effective than bibliotherapy. • In studies reporting accurate estimates of time, CCBT appears to reduce therapist compared with TCBT and is therefore of where access to TCBT is limited. • CCBT may form a useful component of a -care programme, being one of the offered to patients as a first-line approach. • There is evidence to support the effectiveness Beating the Blues and FearFighter. -effectiveness: studies performed an economic analysis of. Therefore the only available economic was provided by the four sponsor submissions. These were critically reviewed and from them used in a modelling exercise. • CCBT using Stresspac was found to cost more, was no better in terms of patient outcomes TAU. • The cost per patient of Cope was less than the costs for CBT and drug therapy. • CCBT using FearFighter was stated to be less than CBT and drug therapy. • There was insufficient data in the Calipso to make any judgement regarding efficiency of Calipso relative to alternative options. • The results of the economic analysis of CCBT Beating the Blues indicated that compared TAU, Beating the Blues is a costeffective for treating patients with and depression. The economic analysis in this submission is the most of all the submissions.: baseline assumptions, the cost in the first of implementing Beating the Blues with an psychologist is £21, 691. If a practice nurse used, the cost is £25, 192. The corresponding for Stresspac and FearFighter are £19, 902 £22, 574, respectively. baseline assumptions, Beating the Blues an assistant psychologist was estimated to £275 million in England and £13 million Wales. If a practice nurse is used, the corresponding were £237 million in England and £11 million in Wales. The costs for Stresspac estimated to be £206 million in England £10 million in Wales. view of the data deficiencies and the large of assumptions made, all the model should be treated with caution. per QALY: on a number of assumptions, one set of suggest that the incremental cost per QALY of Beating the Blues over TAU lies between £1209. 68 and £7692. 30. If the data from another set are used, the corresponding range lies £3000 and £6667 per QALY gained. It be stated once again, however, that these are crude and should be treated caution.: is limited evidence of poor-to-moderate that CCBT may be effective in the treatment depression, anxiety and phobias. The evidence CCBT is uncertain as the studies varied in setting, patient populations, comparators outcome measures. Further research is in order to answer the many questions the design and implementation CCBT programmes. for further research: • Studies are needed to determine the level therapist involvement needed to produce outcomes for patients using programmes. • Studies need to be undertaken within the practice setting. • Efforts should be made to include patients with -morbidities routinely treated within general care. • The position of CCBT within a stepped-care needs to be identified as well as relationship to other efforts to increase to CBT and psychological therapies. • Appropriate comparison groups must be in studies, such as bibliotherapy and self-help approaches to treatment that therapist time. important research issues include the of patients from a variety of socioeconomic ethnic backgrounds, different age and both males and females. Co-morbidity medication need to be taken into account in design. Also further research is needed to patients who cannot currently access because they are housebound may from CCBT. design issues include the need for independent, the need for good quality of adequate power using appropriate comparison and well-validated outcome measures. of CCBT packages that warrant research are the type and amount of CBT to incorporate, length and frequency of, amount of homework and the appropriate and computer interface necessary for effective usage. Readability and legibility of materials must also be taken into account.
Kaltenthaler et al. (Tue,) studied this question.