COST-EFFECTIVENESS OF GUIDED INTERNET-BASED TREATMENTS FOR DEPRESSION IN COMPARISON WITH CONTROL CONDITIONS: AN INDIVIDUAL PARTICIPANT DATA META-ANALYSIS

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Abstract

Objectives: Previous studies have shown the effectiveness of guided Internetbased
interventions for depression compared to control groups. It is often hypothesized
that Internet-based treatments are associated with lower costs, because
face-to-face time with therapist is reduced. The objective of this study was to
conduct an individual-participant data meta-analysis (IPD-MA) evaluating the costeffectiveness
of guided Internet-based interventions for depression compared to
controls from a societal perspective. Methods: A systematic literature search
was conducted in electronic databases from 2000 to January 1st 2017. Studies
were included if they were randomized controlled trials (RCTs) in which the costeffectiveness
of a guided Internet-based intervention for depression was compared
to a control. Cost-effectiveness analyses were conducted for improvement in depressive
symptoms measured by CES-D, response to treatment, and Quality-Adjusted
Life-Years (QALYs) at 8-weeks, 6-months, and 12-months follow-up. Results: IPD from five studies, including 1,426 participants were used. The guided Internet-based
interventions were more costly than the controls, but not statistically significantly
so (e.g.12-months mean difference = € 406, 95%CI: -611 to 1,444). Cost-effectiveness
acceptability curves indicated that high investments are needed to reach an acceptable
probability that the intervention is cost-effective compared to control for CES-D
and response to treatment (e.g., at 12-month follow-up the probability of being costeffective
was 0.95 at a ceiling ratio of 2,000 € /point of improvement in CES-D score).
For QALYs, the intervention’s probability of being cost-effective compared to control
was low at the commonly accepted willingness-to-pay threshold (e.g., at 12-month
follow-up the probability was 0.29 and 0.31 at a ceiling ratio of 24,000 and 35,000
€ /QALY, respectively). Conclusions: Guided Internet-based interventions for
depression were not considered cost-effective compared to control. However, only
a minority of RCTs investigating the clinical effectiveness of guided Internet-based
interventions also assessed cost-effectiveness. Therefore, it is important that future
RCTs measure resource use and productivity losses alongside clinical effectiveness.
Original languageEnglish
Pages (from-to)A714-A715
JournalValue in Health
Volume20
Issue number9
Publication statusPublished - 2017

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