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Cost-effectiveness of behavioural activation therapy for depression: A structured literature review

Code : SKPT_25_105
Publish date : 28/08/2026
Page : 31-50
Author : Bui Bich Huong
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Bui Bich Huong ₁ - Hanoi University of Public Health

Objectives: This structured literature review aimed to synthesise current evidence on the cost-effectiveness of behavioural activation (BA) therapy for depression across different settings.

Methods: A structured literature search was conducted in PubMed, the Cochrane Library, and International Network of Agencies for Health Technology Assessment (INAHTA) databases, with the last search performed in September 2025. Eligible studies were randomised controlled trials that included an economic evaluation of BA interventions for adults with depression; studies were excluded if they were study protocols or unpublished. Risk of bias was assessed using the Cochrane RoB 2.0 tool and CHEERS 2022 checklist. Results were synthesised using a narrative approach, with cost and quality-adjusted life years (QALYs) outcomes compared across studies and incremental cost-effectiveness ratios summarised when available. The review followed Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and applied the PICO framework (Population: Adults with depression; Intervention: behavioural activation; Comparator: usual care or alternative treatments; Outcomes: cost-effectiveness and cost-utility analyses.

Results: Ten Randomized Controlled Trial (RCT)-based economic evaluations met the inclusion criteria, conducted across six countries (United Kingdom (UK): 6 studies, Hong Kong, the Netherlands, United States of America (USA), Spain, and India) and various care settings, primarily primary care. Most studies adopted a healthcare or public service payer perspective, with time horizons ranging from 3 to 18 months, and one model-based study applying a lifetime horizon. Across studies, BA consistently demonstrated favourable cost-effectiveness (9/10 studies), with reported incremental cost-effectiveness ratios (ICERs) falling well below commonly used willingness-to-pay thresholds, typically £30,000 per QALY. Two studies reported BA as dominant while only one study found BA not cost-effective compared with an active comparator. Probabilistic sensitivity analyses confirmed that BA had a high probability of being cost-effective under most scenarios.

Conclusion: Evidence from high-income countries suggests that BA may be a cost-effective and scalable intervention for depression. Nevertheless, the applicability of these findings to low- and middle-income countries, such as Vietnam, remains uncertain due to differences in health system contexts and cost structures.

DOI : https://doi.org/10.38148/JHDS.102E/SKPT_25_105
Topics : Health policy
Type of article : Review papers
Specialized : Medical

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