Cost-Utility and Cost-Effectiveness of Internet-Based Treatment for Adults With Depressive Symptoms: Randomized Trial

BACKGROUND The effectiveness of Internet-based treatments for depression has been demonstrated; their cost-effectiveness, however, has been less well researched. OBJECTIVE Evaluating the relative cost-utility and cost-effectiveness of (1) Internet-based cognitive behavioral therapy, (2) Internet-based problem-solving therapy, and (3) a waiting list for adults with depressive symptoms. METHODS A total of 263 participants with clinically significant depressive symptoms were randomized to Internet-based cognitive behavioral therapy (n = 88), Internet-based problem-solving therapy (n = 88), and a waiting list (n = 87). End points were evaluated at the 12-week follow-up. RESULTS Cost-utility analysis showed that cognitive behavioral therapy and problem-solving therapy had a 52% and 61% probability respectively of being more acceptable than waiting when the willingness to pay is € 30,000 for one quality-adjusted life-year. When society is prepared to pay € 10,000 for a clinically significant change from depression, the probabilities of cognitive behavioral therapy and problem-solving therapy being more acceptable than waiting are 91% and 89%, respectively. Comparing both Internet-based treatments showed no clear preference for one or the other of the treatments. CONCLUSIONS Both Internet-based treatments have a high probability of being cost-effective with a modest value placed on clinically significant change in depressive symptoms. TRIAL REGISTRATION ISRCTN16823487; http://www.controlled-trials.com/ISRCTN16823487 (Archived by WebCite at http://www.webcitation.org/5u8slzhDE).