Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 19, 2018
Date Accepted: May 7, 2019
The Cost-Effectiveness of an Internet Intervention to Facilitate Mental Health Help-Seeking by Young Adults: Results of a Randomised controlled trial
ABSTRACT
Background:
Little empirical evidence is available to support the effectiveness and cost-effectiveness of internet interventions to increase help-seeking behaviour for mental health in young adults.
Objective:
To evaluate the cost-effectiveness of an online mental health help-seeking navigation tool (Link) in comparison to usual help-seeking strategies.
Methods:
A cost-utility analysis alongside the main randomised trial of Link was conducted from the Australian health care sector perspective. Four hundred and thirteen young adults aged 18-25 years were randomized to the Link intervention or usual care with one and three-month follow-up. The main outcome for the current study was quality-adjusted life years (QALYs) measured by the AQoL-4D. Costs were calculated based on self-reported resource use questionnaire. Analyses were conducted as intention-to-treat and reported as incremental cost-effectiveness ratios in 2015 Australian Dollars per QALY. Completer analysis was conducted in a sensitivity analysis.
Results:
Significantly more QALYs were gained in the intervention group than the control group (0.15 vs 0.14, P < 0.001). The intervention was associated with significantly lower health professional consultation costs at one month follow up (mean costs $98 vs. $162, P<0.05). Costs of hospital services were lower at three months in the intervention arm (mean costs $47 vs $101), however, there was insufficient sample size to detect a significant difference between groups. There were no statistically significant differences in the total costs between the two arms. Relative to the control group, those who received the intervention experienced 0.01 more QALYs (0.00 to 0.02) and had lower total health sector costs of -$81 (-$348 to $186) over three-months. The intervention was found to be more effective and less costly compared to usual-care. Under a willingness-to-pay value-for money threshold of $28,033 per QALY, the intervention was 100% likely to be cost-effective. Results were robust in the sensitivity analysis.
Conclusions:
Our study found that the online youth mental health help-seeking web service is a cost-effective intervention for young people aged 18-25 compared to usual search strategies. Further research is required to confirm these results. Clinical Trial: This study was registered on the 20th November 2014 with the Australian New Zealand Clinical Trials Registry (Ref #: ACTRN126140012223628), https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366731&isReview=true
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