Cost effectiveness of guided Internet-based interventions for depression in comparison with control conditions: An individual–participant data meta-analysis

Research output: Journal contributionsScientific review articlesResearch

Authors

  • Spyros Kolovos
  • Johanna M. van Dongen
  • Heleen Riper
  • Claudia Buntrock
  • Pim Cuijpers
  • David D. Ebert
  • Anna S. Geraedts
  • Robin M. Kenter
  • Stephanie Nobis
  • Andrea Smith
  • Lisanne Warmerdam
  • Jill A. Hayden
  • Maurits W. van Tulder
  • Judith E. Bosmans

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.

Original languageEnglish
JournalDepression and Anxiety
Volume35
Issue number3
Pages (from-to)209-219
Number of pages11
ISSN1091-4269
DOIs
Publication statusPublished - 03.2018

Bibliographical note

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.

    Research areas

  • cost effectiveness, cost utility, depression, individual–participant data meta-analysis, Internet-based intervention
  • Health sciences
  • Psychology

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