Economic Evaluation of an Internet-Based Preventive Cognitive Therapy With Minimal Therapist Support for Recurrent Depression: Randomized Controlled Trial

Abstract

BackgroundMajor depressive disorder (MDD) is highly recurrent and has a significant disease burden. Although the effectiveness of internet-based interventions has been established for the treatment of acute MDD, little is known about their cost effectiveness, especially in recurrent MDD.ObjectivesOur aim was to evaluate the cost effectiveness and cost utility of an internet-based relapse prevention program (mobile cognitive therapy, M-CT).MethodsThe economic evaluation was performed alongside a single-blind parallel group randomized controlled trial. Participants were recruited via media, general practitioners, and mental health care institutions. In total, 288 remitted individuals with a history of recurrent depression were eligible, of whom 264 were randomly allocated to M-CT with minimal therapist support added to treatment as usual (TAU) or TAU alone. M-CT comprised 8 online lessons, and participants were advised to complete 1 lesson per week. The economic evaluation was performed from a societal perspective with a 24-month time horizon. The health outcomes were number of depression-free days according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) criteria assessed with the Structured Clinical Interview for DSM-IV axis I disorders by blinded interviewers after 3, 12, and 24 months. Quality-adjusted life years (QALYs) were self-assessed with the three level version of the EuroQol Five Dimensional Questionnaire (EQ-5D-3L). Costs were assessed with the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness (TiC-P). Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that M-CT is cost effective compared to TAU.ResultsMean total costs over 24 months were €8298 (US $9415) for M-CT and €7296 (US $8278) for TAU. No statistically significant differences were found between M-CT and TAU regarding depression-free days and QALYs (P=.37 and P=.92, respectively). The incremental costs were €179 (US $203) per depression-free day and €230,816 (US $261,875) per QALY. The cost-effectiveness acceptability curves suggested that for depression-free days, high investments have to be made to reach an acceptable probability that M-CT is cost effective compared to TAU. Regarding QALYs, considerable investments have to be made but the probability that M-CT is cost effective compared to TAU does not rise above 40%.ConclusionsThe results suggest that adding M-CT to TAU is not effective and cost effective compared to TAU alone. Adherence rates were similar to other studies and therefore do not explain this finding. The participants scarcely booked additional therapist support, resulting in 17.3 minutes of mean total therapist support. More studies are needed to examine the cost effectiveness of internet-based interventions with respect to long-term outcomes and the role and optimal dosage of therapist support. Overall, more resea...

Digital Health Interventions in Prevention, Relapse, and Therapy of Mild and Moderate Depression: Scoping Review

“…In the area of relapse prevention, 4 studies from Germany [14-17], 1 study from the Netherlands [18], 1 study from Denmark [19], and 1 from the United States [20] were identified (Multimedia Appendix 1).…”

“…The study periods ranged from 4 weeks to 104 weeks (24 months). Four studies were financed by countries [14,17,18,20], and 2 studies were privately financed [16,19]. One study did not provide information on financing [15].…”

“…One study did not provide information on financing [15]. Six studies differentiated between an IG and a CG [14][15][16][17][18]20]. The studies revealed large differences in sample size, ranging from 41 to 264 participants (mean 182; mode 217.5) when the IG and CG were combined.…”

Digital Mental Health Interventions for Depression

“…Recent systematic reviews suggest that DMHI programs for depression show promise for being costeffective compared to various alternative approaches, particularly when guided by a clinician (Donker et al, 2015;Paganini et al, 2018). Nevertheless, economic evaluations of DMHI as compared to the most cost-effective face-to-face treatments are scarce, and mixed findings have been reported (Ahern et al, 2018;Klein et al, 2018).…”

Improving the Course of Depressive Symptoms After Inpatient Psychotherapy Using Adjunct Web-Based Self-Help: Follow-Up Results of a Randomized Controlled Trial

“…In a large RCT of 2 Web-based cognitive behavioral interventions, which had proven to be effective in prior RCTs, no statistical significant effect could be shown when these interventions have been added to usual care [14]. In an RCT, adding an internet-based relapse prevention program to treatment as usual (TAU) was not cost-effective regarding depression-free days and quality adjusted life years compared with TAU alone [15].…”