Cost effectiveness of guided Internet-based interventions for depression in comparison with control conditions: An individual-participant data meta-analysis.
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.
['Kolovos|Spyros|S|0000-0003-3201-1743', 'van Dongen|Johanna M|JM|', 'Riper|Heleen|H|', 'Buntrock|Claudia|C|', 'Cuijpers|Pim|P|0000-0001-5497-2743', 'Ebert|David D|DD|', 'Geraedts|Anna S|AS|', 'Kenter|Robin M|RM|', 'Nobis|Stephanie|S|', 'Smith|Andrea|A|', 'Warmerdam|Lisanne|L|', 'Hayden|Jill A|JA|', 'van Tulder|Maurits W|MW|', 'Bosmans|Judith E|JE|']
D003362:Cost-Benefit Analysis D003863:Depression D003866:Depressive Disorder D006801:Humans D020407:Internet D017216:Telemedicine
cost effectiveness Internet-based intervention depression individual-participant data meta-analysis cost utility