Economic evaluation of a guided and unguided internet-based CBT intervention for major depression: Results from a multi-center, three-armed randomized controlled trial conducted in primary care
Open accessAbstract
Depression is one of the most common mental disorders and will become one of the leading causes of disability in the world. Internet-based CBT programs for depression have been classified as "well established" following the American Psychological Association criteria for empirically supported treatments. The aim of this study is to analyze the cost effectiveness at 12-month follow-up of the Internet-based CBT program "Smiling is fun" with (LITG) and without psychotherapist support (TSG) compared to usual care. The perspective used in our analysis is societal. A sample of 296 depressed patients (mean age of 43.04 years; 76% female; BDI-II mean score = 22.37) from primary care services in four Spanish regions were randomized in the RCT. The complete case and intention-to-treat (ITT) perspectives were used for the analyses. The results demonstrated that both Internet-based CBT interventions exhibited cost utility and cost effectiveness compared with a control group. The complete case analyses revealed an incremental cost-effectiveness ratio (ICER) of €-169.50 and an incremental cost-utility ratio (ICUR) of €-11389.66 for the TSG group and an ICER of €-104.63 and an ICUR of €-6380.86 for the LITG group. The ITT analyses found an ICER of €-98.37 and an ICUR of €-5160.40 for the TSG group and an ICER of €-9.91 and an ICUR of €496.72 for the LITG group. In summary, the results of this study indicate that the two Internet-based CBT interventions are appropriate from both economic and clinical perspectives for depressed patients in the Spanish primary care system. These interventions not only help patients to improve clinically but also generate societal savings. TRIAL REGISTRATION: clinicaltrials.gov NCT01611818.
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Youthful online engagement makes online intervention delivery attractive, particularly with possible reductions in costs, geographic barriers, and access inequities.
“Youthful online engagement makes online intervention delivery attractive, particularly with possible reductions in costs, geographic barriers, and access inequities [3-6].”
From Online Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth With Major Depressive Disorders: Randomized Controlled Trial. (2021) · cites this paper as [6]
The Introduction (page unavailable) says computerized psychological therapies can overcome accessibility barriers, and the Discussion (page unavailable) reports cost savings for internet-based CBT in Spanish primary-care patients with depression. The paper does not connect online delivery to youthful online engagement or specifically address geographic barriers or access inequities. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe use of remote treatment across the internet has been increasing and its effectiveness has been demonstrated for various intractable diseases.
“The use of remote treatment across the internet has been increasing and its effectiveness has been demonstrated for various intractable diseases [11-14].”
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- Authors
- Romero-Sanchiz, P., Nogueira-Arjona, R., García-Ruiz, A., Luciano, J. V., García Campayo, J., Gili, M., Botella, C., Baños, R., Castro, A., López-Del-Hoyo, Y., Pérez Ara, M. Á., Modrego-Alarcón, M., & Mayoral Cleríes, F.
- Affiliations
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (ES)
- Universitat Jaume I (ES)
- Universitat de València (ES)
- Corresponding author
- Luciano, Juan V.
- Gili, Margalida
- Botella, Cristina
- Baños, Rosa
- Castro, Adoración
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-02-27
- Volume
- 12
- Issue
- 2
- Pages
- e0172741
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5328395
- OpenAlex
- W2593362540
- Cited by
- 78
- References
- 43
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 11 · 2023: 6 · 2022: 12 · 2021: 5 · 2020: 12 · 2019: 9 · 2018: 5 · 2017: 2
- FWCI
- 8.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Repositori UJI (Universitat Jaume I) (publishedVersion, other-oa)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Docusalut (Conselleria de Salut i Consum del Govern de les Illes Balears) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Hispana (submittedVersion, cc-by)
- Repositorio Institucional de la Universidad de Málaga (University of Málaga) (submittedVersion, cc-by)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Zaguan (Universidad de Zaragoza) (submittedVersion, cc-by)
- Funders
- Instituto de Salud Carlos III (PI10/01083, RD12/0005, CB06/03, CM13/00115, CP14/00087)
- 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
- major depressive disorder, internet-based cognitive behavioral therapy, cost-effectiveness, primary care, usual care comparison
- MeSH terms
- Adolescent, Adult, Aged, Cost-Benefit Analysis, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Primary Health Care, Psychotherapy, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Telemedicine, Internet, Young Adult
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