{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T18:31:09Z","timestamp":1787596269519,"version":"build-2736575974"},"reference-count":61,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["CGS-D"],"award-info":[{"award-number":["CGS-D"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Internet-based Cognitive Behavioural Therapy (iCBT) is a scalable alternative to therapist-guided CBT, requiring fewer therapist resources. We compared health system costs in individuals receiving minimally guided iCBT (self-directed online modules with asynchronous therapist support) to those receiving therapist-guided CBT (scheduled, one-on-one sessions) in Ontario, Canada (January 2020\u2013August 2021).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study leveraged linked health-administrative data to estimate person-centred health system costs, overall and mental health (MH)-related, one- and two-years post-treatment for all major healthcare services (emergency departments, hospitalizations, physician visits, long-term\/home care, and outpatient prescription drugs). Generalized linear models were used to examine the effect of treatment modality on costs, adjusting for patient sociodemographic characteristics, clinical factors, and pre-treatment healthcare utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      \u2009=\u2009167 individuals enrolled in iCBT and\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      \u2009=\u2009300 receiving CBT, we found that iCBT recipients were more likely to use MH-related acute care and outpatient services (primary care physicians and psychiatrists) following treatment. The average MH-specific costs per person were $1,668 for iCBT (95% CI $0, $7,299) and $979 ($0, $4,821) for standard CBT 1-year post-treatment and $4,086 ($0, $17,049) and $2,023 ($0, $9,027), respectively, 2 years post-treatment. However, following regression adjustment for sociodemographic characteristics, baseline symptoms, and pre-treatment MH-related service use, there were no statistically significant differences in one-year and two-year post-treatment total or MH-related costs between the groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&gt;\u2009.05). This finding remained robust among individuals meeting criteria for anxiety and depression treatment effectiveness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>iCBT may represent a scalable approach to expanding access to MH care without significantly increasing long-term health system costs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/07067437261477547","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:47:34Z","timestamp":1787323654000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing Health System Costs for Recipients of Minimally Guided Internet-Based Cognitive Behavioural Therapy (iCBT) and Therapist-Guided CBT in Routine Care: A Cohort Study Using Ontario's Linked Health-Administrative Data: Comparaison des co\u00fbts pour le syst\u00e8me de sant\u00e9 entre les personnes suivant une th\u00e9rapie cognitivo-comportementale par Internet (TCCI) avec des orientations minimales et les personnes suivant une TCC men\u00e9e par un ou une th\u00e9rapeute en soins courants : \u00e9tude de cohorte utilisant les donn\u00e9es administratives de sant\u00e9 li\u00e9es en Ontario"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3173-2995","authenticated-orcid":false,"given":"Evgenia","family":"Gatov","sequence":"first","affiliation":[{"name":"University of Toronto"},{"name":"Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3961-6008","authenticated-orcid":false,"given":"Claire De","family":"Oliveira","sequence":"additional","affiliation":[{"name":"University of Toronto"},{"name":"Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada"},{"name":"Centre for Addiction and Mental Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian","family":"Strudwick","sequence":"additional","affiliation":[{"name":"University of Toronto"},{"name":"Centre for Addiction and Mental Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wiljer","sequence":"additional","affiliation":[{"name":"University of Toronto"},{"name":"Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada"},{"name":"University Health Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onil","family":"Bhattacharyya","sequence":"additional","affiliation":[{"name":"University of Toronto"},{"name":"Women's College Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8115-7437","authenticated-orcid":false,"given":"Paul","family":"Kurdyak","sequence":"additional","affiliation":[{"name":"Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada"},{"name":"Centre for Addiction and Mental Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"e_1_3_3_2_2","first-page":"66","article-title":"Effective modalities of virtual care to deliver mental health and addictions services in Canada","volume":"3","author":"Lo B","year":"2022","unstructured":"Lo B, Strudwick G, Mah L. 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