Cost-effectiveness analysis of internet-mediated cognitive behavioural therapy for depression in the primary care setting: results based on a controlled trial

Anna Holst; Cecilia Björkelund; Alexandra Metsini; Jens-Henrik Madsen; Dominique Hange; Eva-Lisa L Petersson; Maria Cm Eriksson; Marie Kivi; Per-Åke Å Andersson; Mikael Svensson

doi:10.1136/bmjopen-2017-019716

Cost-effectiveness analysis of internet-mediated cognitive behavioural therapy for depression in the primary care setting: results based on a controlled trial

BMJ Open. 2018 Jun 14;8(6):e019716. doi: 10.1136/bmjopen-2017-019716.

Authors

Affiliations

¹ Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
² County Council of Värmland, Karlstad, Sweden.
³ Dept of Economics and IT, University West, Trollhättan, Sweden.
⁴ Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden.
⁵ Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
⁶ Department of Economics, School of Business, Economics and Law at University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Abstract

Objective: To perform a cost-effectiveness analysis of a randomised controlled trial of internet-mediated cognitive behavioural therapy (ICBT) compared with treatment as usual (TaU) for patients with mild to moderate depression in the Swedish primary care setting. In particular, the objective was to assess from a healthcare and societal perspective the incremental cost-effectiveness ratio (ICER) of ICBT versus TaU at 12 months follow-up.

Design: A cost-effectiveness analysis alongside a pragmatic effectiveness trial.

Setting: Sixteen primary care centres (PCCs) in south-west Sweden.

Participants: Ninety patients diagnosed with mild to moderate depression at the PCCs.

Main outcome measure: ICERs calculated as (Cost_ICBT-Cost_TaU)/(Health outcome_ICBT-Health outcome_TaU)=ΔCost/ΔHealth outcomes, the health outcomes being changes in the Beck Depression Inventory-II (BDI-II) score and quality-adjusted life-years (QALYs).

Results: The total cost per patient for ICBT was 4044 Swedish kronor (SEK) (€426) (healthcare perspective) and SEK47 679 (€5028) (societal perspective). The total cost per patient for TaU was SEK4434 (€468) and SEK50 343 (€5308). In both groups, the largest cost was associated with productivity loss. The differences in cost per patient were not statistically significant. The mean reduction in BDI-II score was 13.4 and 13.8 units in the ICBT and TaU groups, respectively. The mean QALYs per patient was 0.74 and 0.79 in the ICBT and TaU groups, respectively. The differences in BDI-II score reduction and mean QALYs were not statistically significant. The uncertainty of the study estimates when assessed by bootstrapping indicated that no firm conclusion could be drawn as to whether ICBT treatment compared with TaU was the most cost-effective use of resources.

Conclusions: ICBT was regarded to be as cost-effective as TaU as costs, health outcomes and cost-effectiveness were similar for ICBT and TaU, both from a healthcare and societal perspective.

Trial registration number: ID NR 30511.

Keywords: Sweden; cost-effectiveness; icbt; internet mediated cognitive behavioural therapy; primary care.

Publication types

Multicenter Study
Pragmatic Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cognitive Behavioral Therapy / economics
Cognitive Behavioral Therapy / methods*
Cost-Benefit Analysis
Depressive Disorder / economics
Depressive Disorder / therapy*
Female
Humans
Internet*
Male
Middle Aged
Primary Health Care
Psychiatric Status Rating Scales
Quality-Adjusted Life Years
Sweden
Treatment Outcome