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Cost-effectiveness analysis of internet-mediated cognitive behavioural therapy for depression in the primary care setting: results based on a controlled trial
University of Gothenburg, Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
University of Gothenburg, Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
County Council of Värmland, Karlstad, Sweden.
University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics.
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 6, article id e019716Article in journal (Refereed) Published
Abstract [en]

Objective To perform a cost-effectiveness analysis of a randomised controlled trial of internet-mediated cognitive behavioural therapy (ICBT) compared with treatment as usual (Tall) 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))=Delta Cost/Delta Health 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) ((sic)426) (healthcare perspective) and SEK47679 ((sic)5028) (societal perspective). The total cost per patient for TaU was SEK4434 ((sic)468) and SEK50 343 ((sic)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-ll score was 13.4 and 13.8 units in the ICBT and Tall groups, respectively. The mean QALYs per patient was 0.74 and 0.79 in the ICBT and TaU groups, respectively. The differences in BDI-11 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 Tall 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.

Place, publisher, year, edition, pages
2018. Vol. 8, no 6, article id e019716
Keywords [en]
adult, article, Beck, Depression, Inventory, boot strapping, cognitive, behavioral, therapy, controlled, clinical trial, controlled, study cost, effectiveness, analysis, diagnosis, female, follow up, human, Internet, major clinical study, male, primary medical care, quality adjusted life, year registration, Sweden, uncertainty
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
URN: urn:nbn:se:hv:diva-12905DOI: 10.1136/bmjopen-2017-019716ISI: 000435567900024Scopus ID: 2-s2.0-85053137086OAI: oai:DiVA.org:hv-12905DiVA, id: diva2:1251685
Funder
Region Västra Götaland
Note

Funders: REHSAM (Swedish Social Insurance Agency)

Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2019-05-27Bibliographically approved

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Madsen, Jens-Henrik

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