Cost-Effectiveness of Therapist-Guided Internet-Based Cognitive Behavioral Therapy for Stress-Related Disorders: Secondary Analysis of a Randomized Controlled Trial

Lindsäter, Elfin; Axelsson, Erland; Salomonsson, Sigrid; Santoft, Fredrik; Ljótsson, Brjánn; Åkerstedt, Torbjörn; Lekander, Mats; Hedman‐Lagerlöf, Erik

doi:10.2196/14675

Cited by 24 publications

(28 citation statements)

References 53 publications

(76 reference statements)

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“…In the meta-analysis by Heber et al (2017), 26 controlled studies including 4226 participants were analysed, showing small to moderate effects on outcomes on stress (Cohen's d=0.43) In addition to the findings from for-mentioned systematic reviews and metaanalyses, studies also suggest that internet interventions for stress can have sustained effects on stress reduction up to 12-months post intervention Heber et al, 2016;Lindsäter et al, 2018) and be cost-effective (Ebert et al, 2018;Kählke et al, 2019;Lindsäter et al, 2019).…”

Section: Internet-based Stress Interventionsmentioning

confidence: 98%

“…The present thesis would have benefited from including health economic analysis. Even though few studies have investigated the cost-effectiveness of internetbased interventions for stress or stress-related disorders, there is some indications of promising results (Ebert et al, 2018;Kählke et al, 2019;Lindsäter et al, 2019). Interestingly, in the aforementioned studies, the cost-effectiveness was largely driven by a reduction in costs for presenteeism.…”

Section: Health Economic Analysismentioning

confidence: 99%

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Learning how to recover from stress-related disorders via internet-based interventions

Asplund

2021

Linköping Studies in Behavioural Science

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Gerhard Andersson, my main supervisor. We first met at Uppsala university in 1999-2000, when I was a student looking for a scientific project in psychology. From that day on, you have always shown such kindness and openness to new ideas. Your supervision has been very wise and gentle, pushing me when I need to, and generously and trustfully letting me explore and grow as a researcher. And thank you for all the laughs and mischievous pranks (mixing up signs, titles, roles, mugs etcetera). To my delight, I have also noticed that you have picked up some recovery activities during these years.Brjánn Ljótsson, my co-supervisor. I am very grateful for all your valuable support and encouragement during these years. You have really inspired me in testing and applying various statistical methods. And thank you for sharing your experiences and knowledge on becoming a PhD.George Vlaescu (a.k.a. G or Speedy), IT-System developer. Thank you for your quick, invaluable and sometimes crucial support regarding the IT-platform iterapy. Without your quick and methodical work, this research would not have been possible.Per Carlbring, professor and fellow grant applicant. Thank you for your enthusiastic, and super quick responses, and for your helpful and thorough comments on our studies.Master level psychology students and psychotherapy students. Without your commitment and hard work, this would never have been possible. I have enjoyed reading all the comments from grateful participants regarding the importance of your guidance in their treatment. Study I,

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Section: Internet-based Stress Interventionsmentioning

confidence: 98%

Section: Health Economic Analysismentioning

confidence: 99%

Learning how to recover from stress-related disorders via internet-based interventions

Asplund

2021

Linköping Studies in Behavioural Science

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“…As a result of the updated literature search, we identified 10 additional studies that met the inclusion criteria of our review and had been published over the preceding 2 years, [113][114][115][116][117][118][119][120][121][122] as shown in Figure 7. All 10 additional studies used DIs based on CBT delivered via the web/internet 113,114,[116][117][118][119]121,122 or via VR 120 or a mobile app. 115 One study used a non-CBT DI (progressive muscle relaxation).…”

Section: Updated Literature Searches and Additional Studies Retrievedmentioning

confidence: 99%

“…115 One study used a non-CBT DI (progressive muscle relaxation). 119 The comparators against which the DIs were evaluated included NI, 114,115,117,[120][121][122] non-therapeutic controls 118 and NoDIs including face-to-face CBT. 113,116,119 With the exception of one study that recruited adolescents with anxiety, 118 the rest related to adult populations with depression, [113][114][115][116] mixed depression and anxiety, 122 social anxiety, 121 OCD, 119 paranoia in psychosis 120 and stress-related disorders (i.e.…”

Section: Updated Literature Searches and Additional Studies Retrievedmentioning

confidence: 99%

Digital interventions in mental health: evidence syntheses and economic modelling

Gega

Janković

Gonçalves

et al. 2022

Health Technol Assess

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Background Economic evaluations provide evidence on whether or not digital interventions offer value for money, based on their costs and outcomes relative to the costs and outcomes of alternatives. Objectives (1) Evaluate and summarise published economic studies about digital interventions across different technologies, therapies, comparators and mental health conditions; (2) synthesise clinical evidence about digital interventions for an exemplar mental health condition; (3) construct an economic model for the same exemplar mental health condition using the previously synthesised clinical evidence; and (4) consult with stakeholders about how they understand and assess the value of digital interventions. Methods We completed four work packages: (1) a systematic review and quality assessment of economic studies about digital interventions; (2) a systematic review and network meta-analysis of randomised controlled trials on digital interventions for generalised anxiety disorder; (3) an economic model and value-of-information analysis on digital interventions for generalised anxiety disorder; and (4) a series of knowledge exchange face-to-face and digital seminars with stakeholders. Results In work package 1, we reviewed 76 economic evaluations: 11 economic models and 65 within-trial analyses. Although the results of the studies are not directly comparable because they used different methods, the overall picture suggests that digital interventions are likely to be cost-effective, compared with no intervention and non-therapeutic controls, whereas the value of digital interventions compared with face-to-face therapy or printed manuals is unclear. In work package 2, we carried out two network meta-analyses of 20 randomised controlled trials of digital interventions for generalised anxiety disorder with a total of 2350 participants. The results were used to inform our economic model, but when considered on their own they were inconclusive because of the very wide confidence intervals. In work package 3, our decision-analytic model found that digital interventions for generalised anxiety disorder were associated with lower net monetary benefit than medication and face-to-face therapy, but greater net monetary benefit than non-therapeutic controls and no intervention. Value for money was driven by clinical outcomes rather than by intervention costs, and a value-of-information analysis suggested that uncertainty in the treatment effect had the greatest value (£12.9B). In work package 4, stakeholders identified several areas of benefits and costs of digital interventions that are important to them, including safety, sustainability and reducing waiting times. Four factors may influence their decisions to use digital interventions, other than costs and outcomes: increasing patient choice, reaching underserved populations, enabling continuous care and accepting the ‘inevitability of going digital’. Limitations There was substantial uncertainty around effect estimates of digital interventions compared with alternatives. This uncertainty was driven by the small number of studies informing most comparisons, the small samples in some of these studies and the studies’ high risk of bias. Conclusions Digital interventions may offer good value for money as an alternative to ‘doing nothing’ or ‘doing something non-therapeutic’ (e.g. monitoring or having a general discussion), but their added value compared with medication, face-to-face therapy and printed manuals is uncertain. Clinical outcomes rather than intervention costs drive ‘value for money’. Future work There is a need to develop digital interventions that are more effective, rather than just cheaper, than their alternatives. Study registration This study is registered as PROSPERO CRD42018105837. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 1. See the NIHR Journals Library website for further project information.

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“…The type and extent of guidance can vary widely between interventions (Simon et al, 2019). Internet-based interventions typically demand less therapist contact than face-to-face approaches and may be delivered by non-specialist clinicians, therefore impacting on therapist capacity, treatment access, and cost savings (Linds€ ater et al, 2019;Thew, 2020). Greater effects have been shown for guided i-CBT (Andersson, Titov, Dear, Rozental, & Carlbring, 2019;Andersson, Topooco, Havik, & Nordgreen, 2016;Cuijpers, Riper, & Andersson, 2015;Carlbring, Andersson, Cuijpers, Riper, & Hedman-Lagerl€ of, 2017;Lewis, Roberts, Simon, Bethell, & Bisson, 2019), and GSH is advocated within some NICE guidelines, including for depression, general anxiety disorder, panic disorder, and posttraumatic stress disorder (PTSD; NICE, 2009NICE, , 2011NICE, , 2018.…”

Section: Practitioner Pointsmentioning

confidence: 99%

Internet‐based psychological therapies: A qualitative study of National Health Service commissioners and managers views

et al. 2021

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Objectives. To explore in-depth the views on Internet-based psychological therapies and their implementation from the perspective of National Health Service (NHS) commissioners and managers.Design. Qualitative interview study. Method.Ten NHS commissioners and managers participated in a semi-structured, coproduced interview. Each transcribed interview was double-coded and thematically analysed using The Framework Method. Results. Interviews generated three main themes. (1) Capacity issues across psychological therapy services create barriers to face-to-face therapies, and Internet-based interventions offer a solution. (2) Despite reservations, there is growing acceptance of Internet-based therapies. Different ways of connecting with patients are required, and Internet-based treatments are accessible and empowering treatment options, with guided self-help (GSH) preferred. Internet-based interventions may however exclude some individuals and be a threat to the therapeutic relationship between patient and practitioner. (3) Successful roll-out of Internet-based interventions would be facilitated by a strong empirical-or practice-based evidence, a national coordinated approach and timely training and supervision. Barriers to the roll-out include digital intervention set-up costs and delays due to NHS inflexibility.Conclusions. The study highlights factors influencing access to Internet-based therapies, important given the rapid evolution of e-therapies, and particularly timely given increasing use of remote therapies due to COVID-19 restrictions. Interviewees were open to Internet-based approaches, particularly GSH interventions, so long as they do notThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Cost-Effectiveness of Therapist-Guided Internet-Based Cognitive Behavioral Therapy for Stress-Related Disorders: Secondary Analysis of a Randomized Controlled Trial

Cited by 24 publications

References 53 publications

Learning how to recover from stress-related disorders via internet-based interventions

Learning how to recover from stress-related disorders via internet-based interventions

Digital interventions in mental health: evidence syntheses and economic modelling

Internet‐based psychological therapies: A qualitative study of National Health Service commissioners and managers views

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