– Synthesis of Evidence This task reflects the process for reviewing evidence for evidence-based healthcare practice. (Check marking criteria for this task). Select XXXXXXXXXXpapers based on empirical...

THE COST EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY IN THE TREATMENT OF DEPRESSION IN THE UK
Table of Contents
Introduction    3
Critical appraisals and analysis of the papers    3
Conclusion    6
Appendix 1: CASP RCT Assessment Tool    8
Appendix 2: Summary table of studies    8
References    12
THE COST-EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY IN THE TREATMENT OF DEPRESSION IN THE UK.
Introduction
Depression has been identified as the most commonly occu
ing disease among almost every age group. The major reason behind the wide prevalence of this disease in UK is lack of emotional resistance among individual due to fast running lifestyle. Depression is also the most frequently treated disease in primary health care. However, people ignore the treatment of this disease because of high cost required during the procedures. Dr. Aaron in 1960s pioneered a cost effective theory called cognitive behaviour theory (CBT). This paper looks at 4 different studies presenting cost effectiveness of cognitive behavioural therapy (CBT). Papers selected will be outlined, compared, analysed and criticized and the conclusion will be made that depicts whether it is a cost effective theory or not.
Papers selected fulfilled all the three criteria of relating to depression, Cognitive behavioural theory and randomized control trials. Critical Appraisal Skills Programme (CASP) for random control analysis has been applied to the research findings based on the effectiveness of computerized or digital CBT. CASP is a much-targeted tool that provides with a certain set of questions, which are to be answered by the critical analysis of the paper. These questions help to analyse systematically the results provided by a study. A summary table has also been provided at the end that outlined the characteristics of each paper further allowing a more effective comparison and analysis.
Critical appraisals and analysis of the papers
All the 4 papers studied presented a clearly focused issue that is cost effectiveness of the Cognitive Behavioural therapy in accordance to the digital approach.
Richards et al. (2018) tested the cost effectiveness of internet delivered iCBT by focusing basically on the ease to access towards the psychological therapies for depression and anxiety while McCrone et al. (2004), Littlewood et al. (2015) and Duarte et al. (2017) tested the same with the computer delivered CBT. Duarte et al. (2017) presented a revolutionary and a pragmatic study that not only depicts the cost effectiveness of the computerized CBT (cCBT) but also compares usual general practitioner primary care based on cost effectiveness of the treatment.
All of these presented a randomised control trial against a waitlist control group. Overall treatment duration was of 8 weeks in Richards et al. (2018), during which the patients were given lectures online and the assessment was performed post session. While, McCrone et al. (2004) used the therapy criteria having a 15 minutes introduction and then 8 sessions of 50 minute video during each session. A baseline assessment was conducted by Richards et al. (2018) at the end of 8-week session and regular follow-up was taken after 3, 6, 9, 12 months likewise, study presented by Duarte et al. (2017) also mentioned that the analysis was done post treatment for next 2 years however, no other study presented a data related to the follow up from the patients after the therapy.
All of the 4 studies presents a clearly focused issue in terms of cost effectiveness of iCBT on anxiety and depression. However, McCrone et al. (2004) tested every patient with similar treatment. Patients were randomly assigned however, minimum age criteria were kept above 18, and it was kept 18-75 by McCrone et al. (2004), while rest of the 2 studies do not present a clear information regarding the age group criteria used. McCrone et al. (2004) worked with 128 participants who were subjected to the usual care while 146 participants were given computer-delivered CBT, Duarte et al. (2017) functioned with 691 participants however, Richards et al. (2018) and Littlewood et al. (2015) did not provide a clear data related to the number of participants.
Richards et al. (2018) screened only those patients with higher scores on GAD-7 and PHQ-9. Patients included were assessed at regular intervals even after completion of 8-week iCBT. Further, there were certain exclusion and inclusion criteria followed at the time of patient screening and all of them were above 18. The groups were treated equally however, only the control group was allowed to have the treatment after 8-week baseline assessment. A similar screening technique was also performed by Littlewood et al. (2015), in which patients were screened randomly based on scores greater than or equal to 10 in Patient Health Questionnaire-9 (PHQ-9). Participants who were randomised to either of the two investigations received cCBT and usual GP care while the participants who were randomised to the control group were offered usual GP care only. Both participants and researchers were not blind to the treatment. The...