Economic evaluation of a guided and unguided internet-based CBT intervention for major depression: Results from a multi-center, three-armed randomized controlled trial conducted in primary care

Abstract

Depression is one of the most common mental disorders and will become one of the leading causes of disability in the world. Internet-based CBT programs for depression have been classified as “well established” following the American Psychological Association criteria for empirically supported treatments. The aim of this study is to analyze the cost effectiveness at 12-month follow-up of the Internet-based CBT program “Smiling is fun” with (LITG) and without psychotherapist support (TSG) compared to usual care. The perspective used in our analysis is societal. A sample of 296 depressed patients (mean age of 43.04 years; 76% female; BDI-II mean score = 22.37) from primary care services in four Spanish regions were randomized in the RCT. The complete case and intention-to-treat (ITT) perspectives were used for the analyses. The results demonstrated that both Internet-based CBT interventions exhibited cost utility and cost effectiveness compared with a control group. The complete case analyses revealed an incremental cost-effectiveness ratio (ICER) of €-169.50 and an incremental cost-utility ratio (ICUR) of €-11389.66 for the TSG group and an ICER of €-104.63 and an ICUR of €-6380.86 for the LITG group. The ITT analyses found an ICER of €-98.37 and an ICUR of €-5160.40 for the TSG group and an ICER of €-9.91 and an ICUR of €496.72 for the LITG group. In summary, the results of this study indicate that the two Internet-based CBT interventions are appropriate from both economic and clinical perspectives for depressed patients in the Spanish primary care system. These interventions not only help patients to improve clinically but also generate societal savings.Trial Registration: clinicaltrials.gov NCT01611818

Positive and Negative Affect Schedule (PANAS): psychometric properties of the online Spanish version in a clinical sample with emotional disorders

“…The literature presents considerable evidence about the efficacy of Internet-based interventions for emotional disorders [73,74]. Recently in our country, studies have been carried out that also guarantee their efficacy [75][76][77], and so it is important to have validated online assessment tools that can be used to assess PA and NA (two core symptoms) in research and clinical settings. In this regard, the present study provides empirical evidence about the usefulness of the instrument in distinguishing between PA and NA with a digital version of the questionnaire.…”

Randomized controlled trial on the effect of Internet-based Cognitive Behavioral Therapy with Real-Time Therapist Support Via a Video Conference for patients with chronic pain: A study protocol

“…Remote treatment via the internet has been increasing and has demonstrated its effectiveness 11,12,13,14 . Since internet-based CBT is easy to access and can be administered at home, it can be considered a convenient intervention for patients who have difficulty traveling to hospitals due to pain.…”

The selection of comparators for randomized controlled trials of health-related behavioral interventions: recommendations of an NIH expert panel

“…It may also be helpful to consider whether an apparent limitation "is a feature, not a bug." Differential attention, for example, could be problematic in a dismantling trial [65], but it is inseparable from the primary research question in eHealth and mHealth trials in which an app is augmented with counselor support in one group but not in the other [78]. It is also an essential feature of the trial if the research question is whether the outcome of an intervention is superior to that of existing practices, services, or treatments that provide less (or more) attention [6].…”