JMIR Publications

ABSTRACT

Background:

Chronic stress is associated with significant suffering, functional impairment and high societal costs. Internet-based cognitive behavioral therapy (ICBT) is a promising treatment for stress-related disorders but has so far not been subjected to health-economic evaluation.

Objective:

To evaluate the cost-effectiveness and cost-utility of ICBT for patients with stress-related disorders. We hypothesized that ICBT, compared to a waitlist control group (WLC), would generate improvements at low net costs, thereby making it cost-effective.

Methods:

Health-economic data were obtained in tandem with a randomized controlled trial of a 12-week ICBT in which patients were randomized to ICBT (n = 50) or to a waitlist control group (n = 50). Health outcomes and costs were surveyed pre- and post-treatment. We calculated incremental cost-effectiveness ratios (ICERs) based on remission rates (cost-effectiveness) and health-related quality of life (cost-utility), and used bootstrap sampling to assess the uncertainty of our results.

Results:

The cost-effectiveness ICER indicated that each patient in remission in ICBT relative to the WLC generated a societal cost saving of $158 pre- to post treatment. ICBT had a 60% probability of being cost-effective at a willingness to pay (WTP) of $0, and a 96% probability of being cost effective at a WTP of $1000. The cost-utility ICER also indicated that ICBT led to improvements in quality of life at no net societal cost. Sensitivity analyses supported the robustness of our results.

Conclusions:

ICBT is indicated to be a cost-effective treatment for patients suffering from chronic stress. Compared to no treatment, ICBT for these patients seems to yield large effects at no or minimal societal net costs. Clinical Trial: ClinicalTrials.gov NCT02540317.