Economic evaluation of an internet-based preventive cognitive therapy with minimal therapist support for recurrent depression: results of a randomized controlled trial (Preprint) [post]

Nicola S Klein, Claudi L H Bockting, Ben Wijnen, Gemma D Kok, Evelien van Valen, Heleen Riper, Pim Cuijpers, Jack Dekker, Colin van der Heiden, Huibert Burger, Filip Smit
2018 unpublished
BACKGROUND Major Depressive Disorder (MDD) is highly recurrent and has a significant disease burden. Although the effectiveness of internet-based interventions has been established for the treatment of acute MDD, little is known about their cost-effectiveness, especially in recurrent MDD. OBJECTIVE Our aim was to evaluate the cost-effectiveness and cost-utility of an internet-based relapse prevention program (Mobile Cognitive Therapy, M-CT). METHODS The economic evaluation was performed
more » ... s performed alongside a single-blind parallel group randomized controlled trial. Participants were recruited via media, general practitioners, and mental health care institutions. In total, 288 remitted individuals with a history of recurrent depression were eligible, of whom 264 were randomly allocated to M-CT with minimal therapist support added to Treatment As Usual (TAU) or TAU alone. M-CT comprised eight online lessons and participants were advised to complete one lesson per week. The economic evaluation was performed from a societal perspective with a 24-month time horizon. The health outcomes were number of depression-free days based on DSM-IV criteria assessed with the Structured Clinical Interview for DSM-IV axis I disorders by blinded interviewers after 3, 12, and 24 months. Quality-Adjusted Life Years (QALYs) were self-assessed with the EQ-5D-3L. Costs were assessed with the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness (TiC-P). Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were used to assess the probability that M-CT is cost-effective compared to TAU. RESULTS Costs were higher and outcomes slightly better for M-CT. The incremental costs were €179 per depression-free day and €230,816 per QALY. The cost-effectiveness acceptability curves suggested that for depression-free days high investments have to be made to reach an acceptable probability that M-CT is cost-effective compared to TAU. Regarding QALYs, considerable investments have to be made but the probability that M-CT is cost-effective compared to TAU does not rise above 40%. CONCLUSIONS The results suggest that adding M-CT to TAU is not effective and cost-effective compared to TAU alone. Adherence rates were similar to other studies and therefore do not explain this finding. The participants scarcely booked additional therapist support, resulting in 17.3 minutes of mean total therapist support. More studies are needed to examine the cost-effectiveness of internet-based interventions with respect to long-term outcomes and the role and optimal dosage of therapist support. Overall, more research is needed on scalable and cost-effective interventions that can reduce the burden of recurrent MDD. CLINICALTRIAL trialregister.nl NTR2503
doi:10.2196/preprints.10437 fatcat:56dlutamkjgivawow5sbnxyndm