Cost effectiveness of guided Internet-based interventions for depression in comparison with control conditions: An individual-participant data meta-analysis

Kolovos, Spyros; Dongen, Johanna M. van; Riper, Heleen; Buntrock, Claudia; Cuijpers, Pim; Ebert, David Daniel; Geraedts, Anna; Kenter, Robin Maria Francisca; Nobis, Stephanie; Smith, Andrea; Warmerdam, Lisanne; Hayden, Jill A.; Tulder, Maurits W. van; Bosmans, Judith E.

doi:10.1002/da.22714

Cited by 46 publications

(50 citation statements)

References 47 publications

(49 reference statements)

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“…The fourth study, also from the UK [30] reported no significant difference in the clinical effectiveness, service use, or costs of an unguided ICBT compared to a website providing information on mental health problems. Kolovos et al [31] conducted a meta-analysis based on patient-level data from five different RCTs that compared ICBT as add-on to care as usual, problem solving therapy or waiting list. The authors report an ICER of €32,706 per QALY gained for a time horizon of 6 months and concluded that ICBT was not cost effective.…”

Section: Discussionmentioning

confidence: 99%

“…Several systematic reviews, meta-analyses and original studies [25][26][27][28][29][30][31][32][33][34][35] have evaluated the cost-effectiveness of ICBT for use in several psychiatric disorders. However, none of the studies used an established standard treatment such as FCBT as a control and therefore effects are often based on single RCTs with short follow-up periods.…”

Section: Introductionmentioning

confidence: 99%

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Cost–Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation

Baumann

Stargardt

Frey

2020

Appl Health Econ Health Policy

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Background and Objective Unipolar depression is the most common form of depression and demand for treatment, such as psychotherapy, is high. However, waiting times for psychotherapy often considerably exceed their recommended maximum. As a potentially less costly alternative treatment, internet-based cognitive behavior therapy (ICBT) might help reduce waiting times. We therefore analyzed the cost-utility of ICBT compared to face-to-face CBT (FCBT) as an active control treatment, taking differences in waiting time into account. Methods We constructed a Markov model to simulate costs and health outcomes measured in quality-adjusted life years (QALYs) for ICBT and FCBT in Germany. We modeled a time horizon of 3 years using six states (remission, depressed, spontaneous remission, undergoing treatment, treatment finished, death). The societal perspective was adopted. We obtained parameters for transition probabilities, depression-specific QoL, and cost data from the literature. Deterministic and probabilistic sensitivity analyses were conducted. Within a scenario analysis, we simulated different time-to-treatment combinations. Half-cycle correction was applied. Results In our simulation, ICBT generated 0.260 QALYs and saved €2536 per patient compared to FCBT. Our deterministic sensitivity analysis suggests that the base-case results were largely unaffected by parameter uncertainty and are therefore robust. Our probabilistic sensitivity analysis suggests that ICBT is highly likely to be more effective (91.5%), less costly (76.0%), and the dominant strategy (69.7%) compared to FCBT. The scenario analysis revealed that the base-case results are robust to variations in time-to-treatment differences. Conclusion ICBT has a strong potential to balance demand and supply of CBT in unipolar depression by reducing therapist time per patient. It is highly likely to generate more QALYs and reduce health care expenditure. In addition, ICBT may have further positive external effects, such as freeing up capacities for the most severely depressed patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost–Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation

Baumann

Stargardt

Frey

2020

Appl Health Econ Health Policy

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“…Selbstmanagement Interventionen sollte aber keinesfalls wegen vermeintlich niedrigerer Kosten automatisch der Vorzug gegeben werden. Das ist insbesondere deswegen wichtig, weil die Kosteneffektivität von Selbstmanagement Interventionen noch nicht ausreichend untersucht ist [44] während die Kosteneffektivität von Kognitiver Verhaltenstherapie als gesichert gelten kann [21].…”

Section: Behandlung Der Ersten Wahl Bei Leicht Bis Mittelgradiger Depunclassified

Selbstmanagement Interventionen in der Behandlung depressiver Störungen: reif für die klinische Praxis?

Klein¹,

Berger²,

Hautzinger³

et al. 2019

Fortschr Neurol Psychiatr

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ZusammenfassungNur etwa die Hälfte derjenigen, die an einer depressiven Störung leiden, sucht auch eine Behandlung auf. Selbstmanagement Interventionen sind eine Möglichkeit, diese Behandlungslücke zu reduzieren. Diese Interventionen basieren meist auf evidenzbasierten Techniken der Kognitiven Verhaltenstherapie, welche statt durch einen Therapeuten durch ein Computerprogramm vermittelt werden. Zahlreiche Studien belegen die Wirksamkeit dieser Interventionen. Diese Studien werfen allerdings auch eine Reihe an Fragen auf. Diese betreffen die Wirksamkeit sowohl im Fremdrating als auch im Langzeitverlauf und die Wirksamkeit bei schwerer depressiver Symptomatik oder in der Kombination mit antidepressiver Medikation. Schließlich stellt sich die Frage nach dem Einsatz dieser Interventionen bei Patienten in der klinischen Praxis und bei Menschen, die nicht besonders internetaffin sind. Diese Fragen haben wir im Rahmen einer großen randomisiertenStudie adressiert (EVIDENT-Studie). In dieser Studie wurde die Wirksamkeit Intervention deprexis® untersucht. Die Ergebnisse dieser Studie werden in dieser Übersicht zusammengefasst und in den Kontext anderer in Deutschland verfügbarer Interventionen gestellt.

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“…We decided to use costs from a societal perspective because they represent the society's interest and all stakeholder groups [1]. For more information on the calculation of the costs see [21]. As dependent variables, we utilized the QALY and costs that appear after a six-month period.…”

Section: Data and Pre-processingmentioning

confidence: 99%

Predicting Therapy Success and Costs for Personalized Treatment Recommendations Using Baseline Characteristics: Data-Driven Analysis (Preprint)

Bremer¹,

Becker²,

Kolovos³

et al. 2018

Preprint

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Background: Different treatment alternatives exist for psychological disorders. Clinical and cost-effectiveness of treatment is a crucial aspect for policy makers, therapists, as well as patients and thus plays a major role for healthcare decision-making. At the start of an intervention, however, it is often not clear which specific individuals benefit from a particular intervention alternative most and how costs will be distributed on an individual patient level. Objective: This paper aimed at predicting the individual outcome and costs for patients before the start of an Internet-based intervention. Based on these predictions, treatment recommendations can be provided on an individual patient level. Thus, we expand the discussion of personalized treatment recommendation. Methods: Outcomes and costs were predicted based on baseline data of 350 patients from a two-arm randomized controlled trial focusing on the comparison of treatment as usual and blended therapy for depressive disorders. For this purpose, we evaluated various machine learning techniques, compared predictive accuracy, and revealed features that contributed most to the prediction performance. We then combined these predictions and utilized the incremental cost-effectiveness ratio in order to derive individual treatment recommendations before the start of treatment. Results: Predicting clinical outcomes and costs was a challenging task that came with high uncertainty when only utilizing baseline information. However, we were able to predict more accurate than a predefined reference measure in the shape of mean values of the outcome and costs. Questionnaires that include anxiety/depression items and questions regarding the mobility of individuals and their energy level contributed to the prediction performance. It was then illustrated how patients can be allocated to the individually most appropriate treatment type. For an incremental cost-effectiveness threshold of 25,000 €/quality adjusted life years, we demonstrated that our recommendations would have led to slightly worse outcomes (1.8%) but simultaneously a decrease in costs (5.9%). Conclusions: Our results indicate that it was feasible to provide personalized treatment recommendations at baseline and thus allocate patients to the most beneficial treatment type. This approach can potentially lead to an improved decision-making, better outcomes for individuals, and simultaneously reduced health care costs.

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Cost effectiveness of guided Internet-based interventions for depression in comparison with control conditions: An individual-participant data meta-analysis

Cited by 46 publications

References 47 publications

Cost–Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation

Cost–Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation

Selbstmanagement Interventionen in der Behandlung depressiver Störungen: reif für die klinische Praxis?

Predicting Therapy Success and Costs for Personalized Treatment Recommendations Using Baseline Characteristics: Data-Driven Analysis (Preprint)

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