JMIR Publications

ABSTRACT

Background:

Stress is highly prevalent and known to be a risk factor for a wide range of physical and mental disorders. The effectiveness of digital stress management interventions has been confirmed; however, research on its economic merits is still limited.

Objective:

To assess the cost-effectiveness, cost–utility, and cost-benefit of a universal digital stress management intervention for employees compared to a waitlist control condition within a time horizon of 6 months.

Methods:

Recruitment was directed at the German working population. A sample of 396 employees was randomly assigned to the intervention group (n = 198) or the waiting list control (WLC) group (n = 198). The digital stress management intervention included seven sessions plus one booster session and was offered without therapeutic guidance. Health service use, patient and family expenditures, and productivity losses were self-assessed and used for costing from a societal and an employer’s perspective. Costs were related to symptom-free status (PSS-10 score 2 standard deviations below the study population baseline mean) and quality-adjusted life years (QALYs) gained. Sampling error was handled using nonparametric bootstrapping.

Results:

From a societal perspective, the digital intervention had a 56% (55%) probability of being cost-effective at a willingness-to-pay of €0 per symptom-free person (QALY) gained, compared to WLC. This probability increased to 80% at a societal willingness-to-pay of €20,000 per QALY gained. Taking the employer’s perspective, the digital intervention showed a probability for a positive return on investment of 78%.

Conclusions:

Digital preventive stress management for employees appears to be cost-effective societally and provides a favorable return-on-investment for employers. Clinical Trial: German clinical trials register (DRKS00005699)