Economic evaluations of Internet- and mobile-based interventions for depression: a systematic review

Abstract

Background: Depressive disorders are highly prevalent and associated with personal and societal burden such as high economic costs. It is a primary challenge for health care systems worldwide to provide treatment for depression and to prevent new onsets. However, healthcare resources are restricted. Internet- and mobile-based interventions (IMIs) are highlighted as clinical effective in many studies and are often suggested to be cost-effective as well. The present study systematically reviewed the evidence on the cost-effectiveness of IMIs for depression. Methods: A systematic database search was conducted according to PRISMA-guidelines. The search focused on economic evaluations of IMIs for the prevention or treatment of depression. Studies were included that met following eligibility criteria: 1) internet-based treatment or prevention for depression 2) comparison to a control group, 3) economic outcomes, 4) adult participants, 5) RCT. Findings: The search revealed 7 economic evaluations of IMIs for depression (n= 2069 participants). None of these studies focused on prevention. Quality of the studies (according to CHEERS) could be rated as good and four economic evaluations could be judged as cost-effective. Regarding incremental cost-effectiveness ratios (ICER) as additional costs per clinically significant change in depressive symptom severity, ICERs ranged from €1,248 to €1,817. ICER per quality-adjusted life year gained ranged from €2,899.87 to €532,959. Discussion: IMIs are a promising approach in the treatment of depression and show high probabilities to be cost-effective. However, the evidence is still sparse and there is particularly a need for economic evaluations of IMIs for the prevention of depression.