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 - 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 - Internet-based intervention
KW - cost effectiveness
KW - cost utility
KW - depression
KW - individual–participant data meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85040543447&partnerID=8YFLogxK
U2 - 10.1002/da.22714
DO - 10.1002/da.22714
M3 - Review article
C2 - 29329486
AN - SCOPUS:85040543447
SN - 1091-4269
VL - 35
SP - 209
EP - 219
JO - Depression and Anxiety
JF - Depression and Anxiety
IS - 3
ER -
