JMIR Publications

ABSTRACT

Background:

Work-related stress is widespread among employees and associated with high costs for the society. Internet-based stress management interventions (iSMI) are effective in reducing such stress. However, evidence for their cost-effectiveness is scant.

Objective:

The aim of the study was to evaluate the cost-effectiveness (CEA) and cost-utility (CUA) of a guided iSMI with mobile support for employees.

Methods:

A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale, PSS-10 ≥ 22) was assigned to either the iSMI or to a waitlist control condition (WLC) with unrestricted access to treatment as usual. Participants were recruited in 2013, followed through 2014, and data analyzed in 2017. The iSMI consisted of 7 sessions plus one booster session and was based on problem-solving and emotion regulation techniques. Costs were measured from the societal perspective, in-cluding all direct and indirect medical and non-medical costs. Costs were related to symp-tomatic remission in the CEA and to gains in quality adjusted life years (QALYs) in the CUA. Statistical uncertainty was handled using bootstrapping (N=5000).

Results:

At a willingness-to-pay (WTP) ceiling of €0 for becoming free of self-perceived stress symptoms, there was a 70% probability of the intervention being more cost-effective than WLC. This rose to 85% and 93% when society is willing to pay €1000 and €2000 achieving symptomatic remission, respectively. The CUA yielded a 76% probability of the interven-tion being more cost-effective than WLC at a conservative WTP threshold of €20,000 ($25,800) per QALY gained.

Conclusions:

From the societal perspective, offering iSMI to stressed employees has an acceptable likeli-hood of being cost-effective compared to WLC. Clinical Trial: German Clinical Trials Register (DRKS): 00004749; http://drks-neu.uniklinik-freiburg.de/ drks_web/setLocale_EN.do (Archived by WebCite at http://www.webcitation.org/6e8rl98nl )