Cost-effectiveness of internet-based cognitive–behavioural therapy and physical exercise for depression

BACKGROUND: Both internet-based cognitive–behavioural therapy (ICBT) and physical exercise are alternatives to treatment as usual (TAU) in managing mild to moderate depression in primary care. AIMS: To determine the cost-effectiveness of ICBT and physical exercise compared with TAU in primary care. METHOD: Economic evaluation of a randomised controlled trial (N = 945) in Sweden. Costs were estimated by a service use questionnaire and used together with the effects on quality-adjusted life-years (QALYs). The primary 3-month healthcare provider perspective in primary care was complemented by a 1-year societal perspective. RESULTS: The primary analysis showed that incremental cost per QALY gain was €8817 for ICBT and €14 571 for physical exercise compared with TAU. At the established willingness-to-pay threshold of €21 536 (£20 000) per QALY, the probability of ICBT being cost-effective is 90%, and for physical exercise is 76%, compared with TAU. CONCLUSIONS: From a primary care perspective, both ICBT and physical exercise for depression are likely to be cost-effective compared with TAU. DECLARATION OF INTEREST: None.