TY - JOUR

T1 - Cost effectiveness of guided Internet-based interventions for depression in comparison with control conditions

T2 - An individual–participant data meta-analysis

AU - Kolovos, Spyros

AU - van Dongen, Johanna M.

AU - Riper, Heleen

AU - Buntrock, Claudia

AU - Cuijpers, Pim

AU - Ebert, David D.

AU - Geraedts, Anna S.

AU - Kenter, Robin M.

AU - Nobis, Stephanie

AU - Smith, Andrea

AU - Warmerdam, Lisanne

AU - Hayden, Jill A.

AU - van Tulder, Maurits W.

AU - Bosmans, Judith E.

N1 - Funding Information: The current study has been conducted within the E-COMPARED framework (603098). The E-COMPARED project is funded under the Seventh Framework Program. The content of this article reflects only the authors’ views and the European Community is not liable for any use that may be made of the information contained therein. Publisher Copyright: © 2018, The Authors. Depression and Anxiety published by Wiley Periodicals, Inc.

PY - 2018/3

Y1 - 2018/3

N2 - Background: There is limited evidence on the cost effectiveness of Internet-based treatments for depression. The aim was to evaluate the cost effectiveness of guided Internet-based interventions for depression compared to controls. Methods: Individual–participant data from five randomized controlled trials (RCT), including 1,426 participants, were combined. Cost-effectiveness analyses were conducted at 8 weeks, 6 months, and 12 months follow-up. Results: The guided Internet-based interventions were more costly than the controls, but not statistically significant (12 months mean difference = €406, 95% CI: − 611 to 1,444). The mean differences in clinical effects were not statistically significant (12 months mean difference = 1.75, 95% CI: −.09 to 3.60 in Center for Epidemiologic Studies Depression Scale [CES-D] score,.06, 95% CI: −.02 to.13 in response rate, and.00, 95% CI: −.03 to.03 in quality-adjusted life-years [QALYs]). 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 cost effective was.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.29 and. 31 at a ceiling ratio of 24,000 and 35,000 €/QALY, respectively). Conclusions: Based on the present findings, guided Internet-based interventions for depression are not considered cost effective compared to controls. However, only a minority of RCTs investigating the clinical effectiveness of guided Internet-based interventions also assessed cost effectiveness and were included in this individual–participant data meta-analysis.

AB - Background: There is limited evidence on the cost effectiveness of Internet-based treatments for depression. The aim was to evaluate the cost effectiveness of guided Internet-based interventions for depression compared to controls. Methods: Individual–participant data from five randomized controlled trials (RCT), including 1,426 participants, were combined. Cost-effectiveness analyses were conducted at 8 weeks, 6 months, and 12 months follow-up. Results: The guided Internet-based interventions were more costly than the controls, but not statistically significant (12 months mean difference = €406, 95% CI: − 611 to 1,444). The mean differences in clinical effects were not statistically significant (12 months mean difference = 1.75, 95% CI: −.09 to 3.60 in Center for Epidemiologic Studies Depression Scale [CES-D] score,.06, 95% CI: −.02 to.13 in response rate, and.00, 95% CI: −.03 to.03 in quality-adjusted life-years [QALYs]). 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 cost effective was.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.29 and. 31 at a ceiling ratio of 24,000 and 35,000 €/QALY, respectively). Conclusions: Based on the present findings, guided Internet-based interventions for depression are not considered cost effective compared to controls. However, only a minority of RCTs investigating the clinical effectiveness of guided Internet-based interventions also assessed cost effectiveness and were included in this individual–participant data meta-analysis.

KW - cost effectiveness

KW - cost utility

KW - depression

KW - individual–participant data meta-analysis

KW - Internet-based intervention

KW - Health sciences

KW - Psychology

UR - http://www.scopus.com/inward/record.url?scp=85040543447&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/fdc988b3-5518-3e86-b522-5230a97de55f/

U2 - 10.1002/da.22714

DO - 10.1002/da.22714

M3 - Scientific review articles

C2 - 29329486

AN - SCOPUS:85040543447

VL - 35

SP - 209

EP - 219

JO - Depression and Anxiety

JF - Depression and Anxiety

SN - 1091-4269

IS - 3

ER -