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 coûts pour le système de santé entre les personnes suivant une thérapie cognitivo-comportementale par Internet (TCCI) avec des orientations minimales et les personnes suivant une TCC menée par un ou une thérapeute en soins courants : étude de cohorte utilisan

Authors

Evgenia Gatov, Claire De Oliveira, Gillian Strudwick, David Wiljer, Onil Bhattacharyya, Paul Kurdyak

Published in

Canadian journal of psychiatry. Revue canadienne de psychiatrie. Pages 7067437261477547. Aug 21, 2026. Epub Aug 21, 2026.

Abstract

ObjectiveInternet-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-August 2021).MethodsThis 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.ResultsAmong N = 167 individuals enrolled in iCBT and N = 300 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 (P > .05). This finding remained robust among individuals meeting criteria for anxiety and depression treatment effectiveness.ConclusionsiCBT may represent a scalable approach to expanding access to MH care without significantly increasing long-term health system costs.

PMID:
42627350
Bibliographic data and abstract were imported from PubMed on 21 Aug 2026.

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