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Guided Internet-Based Cognitive Behavioral Therapy for Depression: Implementation Cost-Effectiveness Study
Jordi Piera-Jiménez1,2,3, Anne Etzelmueller4, Spyros Kolovos5
1Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.
Journal of Medical Internet Research
|May 11, 2021
Summary
Internet-based cognitive behavioral therapy (iCBT) for major depressive disorder, like the Super@ program, is more expensive than usual care but proves cost-effective in Spain. This approach offers a viable treatment option within the established willingness-to-pay threshold.
Area of Science:
- Mental Health
- Health Economics
- Digital Health
Background:
- Major depressive disorder (MDD) is a chronic condition with increasing prevalence in aging populations.
- Internet-based cognitive behavioral therapy (iCBT) demonstrates proven efficacy in treating MDD.
Purpose of the Study:
- To assess the cost-effectiveness of the Super@ program, a community internet-based cognitive behavioral therapy intervention for MDD in Spain.
- Evaluate the Super@ program against usual care from both healthcare and societal perspectives.
Main Methods:
- A 3-state Markov model was employed using the MAFEIP tool to evaluate cost-effectiveness.
- Data on costs and effectiveness were prospectively collected for the Super@ program and from literature for usual care.
- Patient Health Questionnaire-9 (PHQ-9) scores were used to determine health states, transition probabilities, and utilities.
Main Results:
- The Super@ intervention was more costly than usual care, with incremental cost-effectiveness ratios (ICERs) of €29,367 (discounted) and €26,484 (nondiscounted) per quality-adjusted life-year (QALY).
- The intervention was deemed cost-effective, falling within Spain's €30,000 willingness-to-pay (WTP) threshold per QALY.
- Sensitivity analyses indicated that cost reductions through scale-up could lower the ICER, but exceeding the WTP threshold was possible with a 5% discount in incremental effects.
Conclusions:
- The Super@ internet-based cognitive behavioral therapy program for MDD is more expensive than usual care.
- Despite higher costs, the Super@ program's implementation in Spain is considered cost-effective based on the €30,000 WTP threshold.
- This digital mental health intervention presents a valuable option for treating major depressive disorder within the Spanish healthcare and societal context.
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