TY - JOUR

T1 - A Universal Digital Stress Management Intervention for Employees

T2 - Randomized Controlled Trial with Health-Economic Evaluation

AU - Freund, Johanna

AU - Smit, Filip

AU - Lehr, Dirk

AU - Zarski, Anna Carlotta

AU - Berking, Matthias

AU - Riper, Heleen

AU - Funk, Burkhardt

AU - Ebert, David Daniel

AU - Buntrock, Claudia

N1 - Publisher Copyright: ©Johanna Freund, Filip Smit, Dirk Lehr, Anna-Carlotta Zarski, Matthias Berking, Heleen Riper, Burkhardt Funk, David Daniel Ebert, Claudia Buntrock. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 22.10.2024.

PY - 2024/10/22

Y1 - 2024/10/22

N2 - BACKGROUND: Stress is highly prevalent and known to be a risk factor for a wide range of physical and mental disorders. The effectiveness of digital stress management interventions has been confirmed; however, research on its economic merits is still limited. OBJECTIVE: This study aims to assess the cost-effectiveness, cost-utility, and cost-benefit of a universal digital stress management intervention for employees compared with a waitlist control condition within a time horizon of 6 months. METHODS: Recruitment was directed at the German working population. A sample of 396 employees was randomly assigned to the intervention group (n=198) or the waitlist control condition (WLC) group (n=198). The digital stress management intervention included 7 sessions plus 1 booster session, which was offered without therapeutic guidance. Health service use, patient and family expenditures, and productivity losses were self-assessed and used for costing from a societal and an employer's perspective. Costs were related to symptom-free status (PSS-10 [Perceived Stress Scale] score 2 SDs below the study population baseline mean) and quality-adjusted life years (QALYs) gained. The sampling error was handled using nonparametric bootstrapping. RESULTS: From a societal perspective, the digital intervention was likely to be dominant compared with WLC, with a 56% probability of being cost-effective at a willingness-to-pay (WTP) of €0 per symptom-free person gained. At the same WTP threshold, the digital intervention had a probability of 55% being cost-effective per QALY gained relative to the WLC. This probability increased to 80% at a societal WTP of €20,000 per QALY gained. Taking the employer's perspective, the digital intervention showed a probability of a positive return on investment of 78%. CONCLUSIONS: Digital preventive stress management for employees appears to be cost-effective societally and provides a favorable return on investment for employers. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005699; https://drks.de/search/en/trial/DRKS00005699.

AB - BACKGROUND: Stress is highly prevalent and known to be a risk factor for a wide range of physical and mental disorders. The effectiveness of digital stress management interventions has been confirmed; however, research on its economic merits is still limited. OBJECTIVE: This study aims to assess the cost-effectiveness, cost-utility, and cost-benefit of a universal digital stress management intervention for employees compared with a waitlist control condition within a time horizon of 6 months. METHODS: Recruitment was directed at the German working population. A sample of 396 employees was randomly assigned to the intervention group (n=198) or the waitlist control condition (WLC) group (n=198). The digital stress management intervention included 7 sessions plus 1 booster session, which was offered without therapeutic guidance. Health service use, patient and family expenditures, and productivity losses were self-assessed and used for costing from a societal and an employer's perspective. Costs were related to symptom-free status (PSS-10 [Perceived Stress Scale] score 2 SDs below the study population baseline mean) and quality-adjusted life years (QALYs) gained. The sampling error was handled using nonparametric bootstrapping. RESULTS: From a societal perspective, the digital intervention was likely to be dominant compared with WLC, with a 56% probability of being cost-effective at a willingness-to-pay (WTP) of €0 per symptom-free person gained. At the same WTP threshold, the digital intervention had a probability of 55% being cost-effective per QALY gained relative to the WLC. This probability increased to 80% at a societal WTP of €20,000 per QALY gained. Taking the employer's perspective, the digital intervention showed a probability of a positive return on investment of 78%. CONCLUSIONS: Digital preventive stress management for employees appears to be cost-effective societally and provides a favorable return on investment for employers. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005699; https://drks.de/search/en/trial/DRKS00005699.

KW - cost-benefit

KW - cost-effectiveness

KW - cost-utility

KW - economic evaluation

KW - employees

KW - internet-based

KW - return-on-investment

KW - stress management

KW - universal prevention

KW - Health sciences

KW - Informatics

KW - Psychology

UR - http://www.scopus.com/inward/record.url?scp=85207161021&partnerID=8YFLogxK

U2 - 10.2196/48481

DO - 10.2196/48481

M3 - Journal articles

C2 - 39437382

AN - SCOPUS:85207161021

VL - 26

JO - Journal of Medical Internet Research

JF - Journal of Medical Internet Research

SN - 1439-4456

M1 - e48481

ER -