Cost-utility and cost-effectiveness of internet-based treatment for adults with depressive symptoms: randomized trial

Abstract

Background: The effectiveness of Internet-based treatments for depression has been demonstrated; their cost-effectiveness, however, has been less well researched.

Objective: Evaluating the relative cost-utility and cost-effectiveness of (1) Internet-based cognitive behavioral therapy, (2) Internet-based problem-solving therapy, and (3) a waiting list for adults with depressive symptoms.

Methods: A total of 263 participants with clinically significant depressive symptoms were randomized to Internet-based cognitive behavioral therapy (n = 88), Internet-based problem-solving therapy (n = 88), and a waiting list (n = 87). End points were evaluated at the 12-week follow-up.

Results: Cost-utility analysis showed that cognitive behavioral therapy and problem-solving therapy had a 52% and 61% probability respectively of being more acceptable than waiting when the willingness to pay is € 30,000 for one quality-adjusted life-year. When society is prepared to pay € 10,000 for a clinically significant change from depression, the probabilities of cognitive behavioral therapy and problem-solving therapy being more acceptable than waiting are 91% and 89%, respectively. Comparing both Internet-based treatments showed no clear preference for one or the other of the treatments.

Conclusions: Both Internet-based treatments have a high probability of being cost-effective with a modest value placed on clinically significant change in depressive symptoms.

Trial registration: ISRCTN16823487; http://www.controlled-trials.com/ISRCTN16823487 (Archived by WebCite at http://www.webcitation.org/5u8slzhDE).

Figure 1

Distribution of bootstrapped incremental cost-effectiveness ratios (ICERs) (n = 5000) in the cost-effectiveness plane and ICER acceptability curve based on willingness to pay for one extra quality-adjusted life-year gained

Figure 2

Distribution of bootstrapped incremental cost-effectiveness ratios (ICERs) (n = 5000) in the cost-effectiveness plane and ICER acceptability curve based on willingness to pay per clinically significant change in depressive symptoms

Figure 3

Distribution of bootstrapped incremental cost-effectiveness ratio (n = 5000) in the cost-effectiveness plane for quality-adjusted life-years (left-hand) and clinically significant change (right-hand).