JMIR Publications

ABSTRACT

Background:

The clinical and cost-related consequences of internet-based depression screening in combination with automated feedback have been rarely investigated. We aimed to conduct the cost-effectiveness analysis (CEA) of the observer-masked, three-armed, randomized controlled trial DISCOVER, which focused on two versions of automated feedback interventions after internet-based depression screening.

Objective:

This study aims to evaluate the cost-effectiveness of automated non-tailored and tailored feedback interventions after internet-based depression screening from a societal perspective.

Methods:

Participants who were undiagnosed but screened positive for depression on an online version of the Patient Health Questionnaire-9 [PHQ-9] ≥10 points) were randomized to automatically receive either no feedback, non-tailored feedback, or tailored feedback. The feedback interventions included the depression screening result, a recommendation to seek professional advice, and brief general information about depression. The tailored feedback was additionally framed according to the individual participant’s characteristics. The time horizon was six months. Main outcome was the incremental cost-effectiveness ratio (ICER) from a societal perspective using quality adjusted life-years (QALY) based on the EQ-5D-5L. Cost-effectiveness acceptability curves (CEAC) were constructed. Furthermore, several sensitivity analyses were conducted.

Results:

1,012 participants (no feedback: 343; non-tailored feedback: 338; tailored feedback: 331) were included. Differences in costs and effects were statistically not significant. Still, ICER results indicated that both no feedback and tailored feedback exhibited dominance over non-tailored feedback. The ICER of tailored feedback compared to no feedback was €109,730/QALY. Cost-effectiveness probability of tailored feedback compared to no feedback ranged between 47% and 76%. Sensitivity analyses showed robustness of results. Subgroup analyses showed high cost-effectiveness probabilities for participants being unsure if they suffered from depression and participants whose suspected depression was confirmed in a clinical interview.

Conclusions:

Six months post-intervention, feedback interventions seem to have no significant effect from a societal perspective. When considering QALY, both tailored feedback as well as no feedback are highly likely to be cost-effective compared to non-tailored feedback. Subgroup analyses revealed subpopulations for which the interventions may be cost-effective. Clinical Trial: ClinicalTrials.gov: NCT04633096