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Published on: April 10, 2026
Cost-effectiveness of therapist-delivered online cognitive-behavioural therapy for depression: randomised controlled
Sandra Hollinghurst1, Tim J Peters, Surinder Kaur
1Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, UK. s.p.hollinghurst@bristol.ac.uk
Background:
Therapist-delivered online cognitive-behavioural therapy (CBT) has been found to be effective for depression in primary care.
Aims:
To determine the cost-effectiveness of online CBT compared with usual care.
Method:
Economic evaluation at 8 months alongside a randomised controlled trial. Cost to the National Health Service (NHS), personal costs, and the value of lost productivity, each compared with outcomes based on the Beck Depression Inventory and quality-adjusted life-years (QALYs). Incremental analysis indicated the NHS cost per QALY gain.
Results:
Online CBT was more expensive than usual care, although the outcomes for the CBT group were better. Cost per QALY gain based on complete case data was £17,173, and £10,083 when missing data were imputed.
Conclusions:
Online CBT delivered by a therapist in real time is likely to be cost-effective compared with usual care if society is willing to pay at least £20,000 per QALY; it could be a useful alternative to face-to-face CBT.
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