Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 3, 2024
Date Accepted: Sep 2, 2025
Cost-effectiveness of app-guided self-management (PTSD Coach) for post-traumatic stress: trial-based economic evaluation
ABSTRACT
Background:
App interventions show promise as effective interventions for trauma-related distress, but evaluations of their cost-effectiveness are scarce.
Objective:
To assess the cost effectiveness of an app-based intervention for self-management of post-traumatic stress compared to no guided self-management.
Methods:
The number of quality-adjusted life years (QALYs) gained or lost, and the costs (SEK, 2023 price level) saved or incurred with intervention, versus comparator at 9 months after exposure, were estimated from a payer perspective based on self-reported functional disability and healthcare utilisation from a randomised controlled trial. The probability of the intervention being cost-effective was calculated over a range of cost-effectiveness thresholds up to SEK 1 million (~€100,000) per QALY and value of information analysis was used to interpret statistical uncertainty in the cost-effectiveness results.
Results:
The intervention was associated with 0.0065 QALYs gained per user (95% CI: ‑0.0219 to 0.0349) and an increment in costs of SEK ‑46,359 (~€‑4,500) per user (‑111,696 to 18,977) compared to no guided self-management. The intervention had a 62% probability of both improving health-related quality of life and saving costs and the probability that it was cost effective remained constant at 92% over our threshold range. The total expected value of perfect information was SEK 5.4 million and was largely attributable to statistical uncertainty in incremental costs.
Conclusions:
The use of a mobile app for self-management of post-traumatic stress was found to be cost effective in a Swedish setting. Our value of information analysis suggests that current research is sufficient to support use of the app in Swedish practice from a cost-effectiveness perspective. However, to support its adoption in other settings or the potential of app-based interventions in general, stronger cost-effectiveness evidence is required. Clinical Trial: ClinicalTrials.gov NCT04094922; https://clinicaltrials.gov/ct2/show/NCT04094922
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