Beating the Blues and NICE

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Beating the Blues and NICE

• Ultrasis UK Ltd
• Charlie Martin

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Beating the Blues

• A Computerised cognitive behavioural therapy
  (CBT) for anxiety and depression
• Developed by Dr Judy Proudfoot and colleagues at
  the Institute of Psychiatry, Kings College,
  London in conjunction with Ultrasis UK Ltd
• Makes effective psychological therapies more
  available and accessible

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CBT - Breaking the Cycle

• Identifies and challenges unhelpful thinking
  patterns and beliefs
• Changes behaviours
• Problem solving
• Task breakdown
• Activity scheduling
• Graded exposure
• Sleep management

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Why computerised CBT (cCBT)

• Psychological therapies can be as effective as
  drugs
• CBT teaches life skills less chance of relapse
• Computerised CBT overcomes difficulties of
  provision in some areas waiting times for face
  to face can be 18months
• Cost compares favourably to drugs and face to face

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Screen Shot
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National Institute of Health and Clinical
Excellence (NICE)

• Issues evidence based Clinical Guidelines for
  diagnosis and treatment of medical conditions
  for example, depression
• Issues evidence-based Guidance regarding the
  effectiveness of specific treatments for
  example, computerised cognitive behaviour therapy

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Developing NICE technology appraisals

• Assessment Report prepared by independent
  academic centre consultants provide information
• Independent panel considers this report and
  evidence from experts and carers
• Appraisal Consultation Document (ACD) prepared
• Consultees and commentators comment on the ACD.
• Final appraisal determination produced (FAD)
• Consultees can appeal against the FAD
• Guidance issued

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CCBT Appraisal - History

• 2001 NICE begins an assessment of CCBT
• Oct 2002 guidance states that . the delivery
  of CCBT may be of value The evidence is,
  however, an insufficient basis on which to
  recommend general introduction..
• NICE bring forward the review of the guidance
• June 2004 Ultrasis submits evidence for review
  by the School of Health and Related Research
  Sheffield

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Evidence Submitted- Summary Content

• Product Description including training, support
  services, manuals.
• User hardware requirements
• Software licensing costs
• Clinical and cost effectiveness
• Acceptability and Satisfaction patients and
  practitioners
• Executive Summary and Declaration
• Total of 280 pages

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Clinical effectiveness- published randomised
controlled trials

• Trials in 11 GP surgeries
• 274 patients randomly allocated to receive, with
  or without medication, Beating The Blues or
  treatment as usual with follow-up assessment at
  6months
• Outcome Measures
• Beck Depression
• Beck Anxiety
• Work and Social Adjustment Scale

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RCT Summary

• Significant improvement over treatment as usual
  
• Effects maintained at 6 month-follow up
• Additive effects of antidepressant medication and
  Beating the Blues
• Gives people more symptom free days than
  treatment as usual
• Suitable for a wide range of people

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RCT Results
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Depression Free Days in 6 Months Post-Treatment
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Cost- effectiveness published paper

• Service use analysis cost of all NHS services
  for all patients in the trial
• Analysis includes GP visits, in-patient care,
  out-patient, counsellors, medication,
  psychologists etc
• Lost employment costs
• Cost-utility analysis

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NICE analysis of Cost effectiveness

• NICE Cost model to assess the likely impact of
  CCBT on the costs and effectiveness of treating
  patients in primary care compared with treatment
  as usual
• Model based on data provided by Ultrasis

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Cost Effectiveness - Summary

• Overall healthcare costs not impacted by Beating
  the Blues
• Significant lowering of lost employment costs
• Cost Utility Analysis shows that the incremental
  cost of using Beating the Blues is low and well
  within the acceptable range for new treatments

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Cost Utility Analysis

• Incremental cost per QALY of using Beating the
  Blues is estimated as being between 415 and
  1801 (NICE analysis)
• Upper limit is usually 30000
• A QALY is a quality adjusted life year life
  expectancy times quality of remaining life years
• A year of perfect health is worth one QALY, death
  is equivalent to zero

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Open Trial

• NICE requested further evidence that Beating the
  Blues worked in routine care- outside the special
  circumstances of a randomised controlled trial
• Outcomes in eleven primary and secondary care
  settings confirm clinical effectiveness

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Patient Satisfaction

• Feedback data from 200 patients
• Features of the programme, satisfaction with the
  treatment and overall helpfulness of the
  treatment all rated very positively

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Practitioner satisfaction

• Seven other papers from practitioners were
  provided
• A Brief Service evaluation of Beating the Blues
  in 37 other locations was provided
• Demonstrated that Beating the Blues can be
  effectively used in different types of service

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The appraisal what happened

• Original target June 2005
• NICE issued two consultation documents (ACDs) -
  significant change after the first consultation
• Appeal against the Final Appraisal Document (FAD)
  in Nov 2005
• Final Guidance published Feb 2006

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National Institute for Health and Clinical
Excellence. Computerised cognitive behaviour
therapy for depression and anxiety. Guidance (Feb
2006)

• 1 Guidance
• This review concerns five specific packages for
  the delivery of computerised cognitive behaviour
  therapy (CCBT) accessed via a referral from a
  general practitioner (GP) three for depression
  (Beating the Blues, COPE and Overcoming
  Depression), one for panic/phobia (FearFighter)
  and one for obsessive compulsive disorder (OCD)
  (OCFighter, previously known as BTSteps).
• 1.1 Beating the Blues is recommended as an option
  for delivering cognitive behaviour therapy (CBT)
  in the management of mild and moderate
  depression.

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Thank You

• cmartin_at_ultrasis.com
• 0207 566 3900