Economic evaluations of internet-based psychological interventions for anxiety disorders and depression: A systematic review
Open accessAbstract
Background Internet-based interventions show clinical effectiveness for treating anxiety disorders and depression and could make mental healthcare more affordable.Methods We searched databases including PubMed; EMBASE; Cochrane Central; PsychINFO; CINAHL; EconLit; and Web of Science from January 1, 2000 to August 21, 2020. Inclusion criteria were: 1) pertained to the treatment or prevention of anxiety disorders or depression; 2) evaluated the use of an internet-delivered psychological intervention; 3) recruited participants; and 4) reported costs or cost-effectiveness.Results Of the 6,069 articles identified, 33 targeted anxiety (N=13) and depression (n=20) and met final inclusion criteria. All studies were from high-income countries. The control conditions and cost components included were heterogeneous. Only eight studies reported costs of developing the intervention. Of 27 studies that made a conclusion about cost-effectiveness, 81% of interventions were cost-effective. The quality of studies included was high based on a quality assessment checklist of economic evaluations, although many studies did not include definitions of cost components or differentiate between patient-side and system-level costs.Limitations Studies varied in methodology, making conclusions about cost-effectiveness difficult. The generalizability of these results is unclear as studies were clustered in a small number of high-income countries and costs vary over time and between regions.Conclusions Internet-delivered interventions appeared to be cost-effective although control conditions and cost component reporting were variable. We propose a checklist of cost components for future cost analyses to better compare intervention costs. More research is needed to describe development costs, cost-effectiveness in low-resource settings, and cost-effectiveness of newer technologies.
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Online training is generally more cost-effective than in-person sessions.
“Additionally, online training is generally more cost-effective than in-person sessions (22–25).”
From Digital resilience interventions for healthcare workers: a systematic review (2025) · cites this paper as [25]
The Discussion reports that 22 of 27 studies found internet-delivered psychological interventions for anxiety or depression cost-effective compared with their control conditions. But the Results show that controls were mostly usual care, waitlists, or other remote interventions; relatively few were in-person CBT. The review therefore does not establish that online training generally outperforms in-person sessions on cost-effectiveness. (LLM, conf=0.86)
Experimental — accuracy not yet measuredInternet-based interventions do not have to involve a dedicated therapist, allowing participants to stay anonymous without adopting a patient role.
“do not have to involve a dedicated therapist, allowing participants to stay anonymous without adopting a patient role”
From Meta-analytic review of online guided self-help interventions for depressive symptoms among college students (2021) · cites this paper as Mitchell et al., 2021
The Results sections on depression and anxiety describe completely self-guided interventions, supporting the point that a dedicated therapist is not required. The paper does not say that participants can remain anonymous or avoid adopting a patient role; the Discussion raises data privacy as an ethical concern instead. Page numbers were not provided in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredInternet-based interventions are cost-effective especially when involving some guidance.
“and are cost-effective especially when involving some guidance”
From Meta-analytic review of online guided self-help interventions for depressive symptoms among college students (2021) · cites this paper as Mitchell et al., 2021
The Discussion (page unavailable) reports that 22 of 27 studies found internet-delivered interventions cost-effective compared with controls. But it explicitly says the review could not assess whether therapist-supported interventions were more cost-effective than those without support, so the “especially when involving some guidance” qualification is not supported. (LLM, conf=0.90)
Experimental — accuracy not yet measuredInternet-based interventions are easily accessible and available all the time to participants.
“Such internet-based interventions are easily accessible and available all the time to participants”
From Meta-analytic review of online guided self-help interventions for depressive symptoms among college students (2021) · cites this paper as Mitchell et al., 2021
The Discussion says internet interventions can be easier to access than in-person care. It does not establish that they are available to participants at all times; it also notes that many evaluated apps are not publicly available. The indexed copy provides section labels but no page numbers. (LLM, conf=0.87)
Experimental — accuracy not yet measured
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- Authors
- Mitchell, L. M., Joshi, U., Patel, V., Lu, C., & Naslund, J. A.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- Sangath (IN)
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Mitchell, Lauren M.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2021-04
- Volume
- 284
- Pages
- 157-182
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC8008508
- OpenAlex
- W3126826193
- Cited by
- 80
- References
- 87
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 23 · 2023: 13 · 2022: 12 · 2021: 6
- FWCI
- 2.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- online psychological intervention, anxiety disorders, depression, cost-effectiveness, economic evaluation, cost components, digital mental health
- MeSH terms
- Internet-Based Intervention, Psychosocial Intervention, Anxiety Disorders, Cost-Benefit Analysis, Depression, Humans
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