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Med."],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Utilization of internet-delivered cognitive behavioural therapy (iCBT) for treating depression and anxiety disorders in stepped-care models, such as the UK\u2019s Improving Access to Psychological Therapies (IAPT), is a potential solution for addressing the treatment gap in mental health. We investigated the effectiveness and cost-effectiveness of iCBT when fully integrated within IAPT stepped-care settings. We conducted an 8-week pragmatic randomized controlled trial with a 2:1 (iCBT intervention: waiting-list) allocation, for participants referred to an IAPT Step 2 service with depression and anxiety symptoms (Trial registration: ISRCTN91967124). The primary outcomes measures were PHQ-9 (depressive symptoms) and GAD-7 (anxiety symptoms) and WSAS (functional impairment) as a secondary outcome. The cost-effectiveness analysis was based on EQ-5D-5L (preference-based health status) to elicit the quality-adjust life year (QALY) and a modified-Client Service Receipt Inventory (care resource-use). Diagnostic interviews were administered at baseline and 3 months. Three-hundred and sixty-one participants were randomized (iCBT, 241; waiting-list, 120). Intention-to-treat analyses showed significant interaction effects for the PHQ-9 (<jats:italic>b<\/jats:italic>\u2009=\u2009\u22122.75, 95% CI \u22124.00, \u22121.50) and GAD-7 (<jats:italic>b<\/jats:italic>\u2009=\u2009\u22122.79, 95% CI \u22124.00, \u22121.58) in favour of iCBT at 8-week and further improvements observed up to 12-months. Over 8-weeks the probability of cost-effectiveness was 46.6% if decision makers are willing to pay \u00a330,000 per QALY, increasing to 91.2% when the control-arm\u2019s outcomes and costs were extrapolated over 12-months. Results indicate that iCBT for depression and anxiety is effective and potentially cost-effective in the long-term within IAPT. Upscaling the use of iCBT as part of stepped care could help to enhance IAPT outcomes. The pragmatic trial design supports the ecological validity of the findings.<\/jats:p>","DOI":"10.1038\/s41746-020-0293-8","type":"journal-article","created":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T10:02:44Z","timestamp":1592215364000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":110,"title":["A pragmatic randomized waitlist-controlled effectiveness and cost-effectiveness trial of digital interventions for depression and anxiety"],"prefix":"10.1038","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0871-4078","authenticated-orcid":false,"given":"Derek","family":"Richards","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0585-4008","authenticated-orcid":false,"given":"Angel","family":"Enrique","sequence":"additional","affiliation":[]},{"given":"Nora","family":"Eilert","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2774-9439","authenticated-orcid":false,"given":"Matthew","family":"Franklin","sequence":"additional","affiliation":[]},{"given":"Jorge","family":"Palacios","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9722-0437","authenticated-orcid":false,"given":"Daniel","family":"Duffy","sequence":"additional","affiliation":[]},{"given":"Caroline","family":"Earley","sequence":"additional","affiliation":[]},{"given":"Judith","family":"Chapman","sequence":"additional","affiliation":[]},{"given":"Grace","family":"Jell","sequence":"additional","affiliation":[]},{"given":"Sarah","family":"Sollesse","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2785-0753","authenticated-orcid":false,"given":"Ladislav","family":"Timulak","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,6,15]]},"reference":[{"key":"293_CR1","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1192\/bjp.186.1.11","volume":"186","author":"P Bower","year":"2005","unstructured":"Bower, P. & Gilbody, S. 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