e-CBT (myCompass), Antidepressant Medication, and Face-to-Face Psychological Treatment for Depression in Australia: A Cost-Effectiveness Comparison
Open accessAbstract
BACKGROUND: The economic cost of depression is becoming an ever more important determinant for health policy and decision makers. Internet-based interventions with and without therapist support have been found to be effective options for the treatment of mild to moderate depression. With increasing demands on health resources and shortages of mental health care professionals, the integration of cost-effective treatment options such as Internet-based programs into primary health care could increase efficiency in terms of resource use and costs. OBJECTIVE: Our aim was to evaluate the cost-effectiveness of an Internet-based intervention (myCompass) for the treatment of mild-to-moderate depression compared to treatment as usual and cognitive behavior therapy in a stepped care model. METHODS: A decision model was constructed using a cost utility framework to show both costs and health outcomes. In accordance with current treatment guidelines, a stepped care model included myCompass as the first low-intervention step in care for a proportion of the model cohort, with participants beginning from a low-intensity intervention to increasing levels of treatment. Model parameters were based on data from the recent randomized controlled trial of myCompass, which showed that the intervention reduced symptoms of depression, anxiety, and stress and improved work and social functioning for people with symptoms in the mild-to-moderate range. RESULTS: The average net monetary benefit (NMB) was calculated, identifying myCompass as the strategy with the highest net benefit. The mean incremental NMB per individual for the myCompass group was AUD 1165.88 compared to treatment as usual and AUD 522.58 for the cognitive behavioral therapy model. CONCLUSIONS: Internet-based interventions can provide cost-effective access to treatment when provided as part of a stepped care model. Widespread dissemination of Internet-based programs can potentially reduce demands on primary and tertiary services and reduce unmet need.
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Internet-delivered (eHealth) prevention programs can provide a cost-effective alternative to traditional approaches by enabling wider dissemination and scalability of effective preventative strategies.
“Internet-delivered (eHealth) prevention programs can provide a cost-effective alternative to traditional approaches, by enabling wider dissemination and scalability of effective preventative strategies [4].”
From A pilot evaluation of a smartphone application for workplace depression (2020) · cites this paper as [4]
The Discussion (Conclusion) reports that myCompass was cost-effective compared with usual care and face-to-face CBT, and says wider dissemination could reduce unmet need. The paper evaluates treatment for depression, not prevention programs or preventative strategies, so the claim extends its finding beyond the studied use. (LLM, conf=0.88)
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Gerhards, S. A. H., de Graaf, L. E., Jacobs, L. E., Severens, J. L., Huibers, M. J. H., Arntz, A. R., Riper, H. M., Widdershoven, G. A. M., Metsemakers, J. F. M., & Evers, S. (2011) · Research Publications (Maastricht University) · Cited by 23 · see citing works
How Much Should the NHS Pay for a QALY?
Haycox, A. R. (2013) · PharmacoEconomics · doi:10.1007/s40273-013-0062-5 · Cited by 4 · cited 1× · see citing works
“An approximate value of AUD 64,000 has been suggested [44] but may vary [45-47].”
Bassilios, B., Nicholas, A., Reifels, L., Machlin, A., Ftanou, M., King, K., Fletcher, J. R., Blashki, G. A., Burgess, P. M., & Pirkis, J. (2013) · Monash University Research Portal (Monash University) · Cited by 4 · see citing works
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Moodle: The cost effective solution for internet cognitive behavioral therapy (I-CBT) interventions
Zhang, M. W. B., & Ho, R. C. M. (2017) · Technology and Health Care · doi:10.3233/thc-161261 · Cited by 247 · see citing works
“Prior studies [5] have compared the cost effectiveness of internet based therapy against that of antidepressant medications and face to face conventional psychotherapy and have highlighted that the cost associated with delivery of cognitive behavioural therapy remains to be high.”
The immediate impact of the 2019 novel coronavirus (COVID-19) outbreak on subjective sleep status
Lin, L.-Y., Wang, J., Ou-yang, X.-Y., Miao, Q., Chen, R., Liang, F.-X., Zhang, Y.-P., Tang, Q., & Wang, T. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.05.018 · Cited by 248 · see citing works
Preventing depression using a smartphone app: a randomized controlled trial
Deady, M., Glozier, N., Calvo, R., Johnston, D., Mackinnon, A., Milne, D., Choi, I., Gayed, A., Peters, D., Bryant, R., et al. (2022) · Psychological Medicine · doi:10.1017/s0033291720002081 · Cited by 85 · see citing works
“However, the costs associated with delivering most traditional face-to-face prevention programs inhibit scalability and make population-wide roll-out of these programs unfeasible (Solomon et al., 2015).”
BackgroundSelf-citationSin, J., Galeazzi, G. M., McGregor, E., Collom, J., Taylor, A. F., Barrett, B. M., Lawrence, V. C., & Henderson, C. (2020) · Journal of Medical Internet Research · doi:10.2196/20581 · Cited by 80 · see citing works
“Sixteen digital interventions were reported in the 19 included studies: 1 brief adjustment disorder intervention was trialed in 2 RCTs in Lithuania [50,51], a web-based acceptance and commitment therapy intervention was tested in 2 studies in Australia [44,45], and a web-based intervention targeting mild-to-moderate d…”
BackgroundInfluential(2019) · Europe PMC (PubMed Central) · Cited by 72 · see citing works
Li, J., Parrott, S., Sweeting, M. J., Farmer, A. A., Ross, J., Dack, C., Pal, K., Yardley, L., Barnard, M., Hudda, M. T., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9256 · Cited by 72 · see citing works
Guo, S., Deng, W., Wang, H., Liu, J., Liu, X., Yang, X., He, C., Zhang, Q., Liu, B., Dong, X., et al. (2020) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2528 · Cited by 72 · see citing works
Miller, S., Ainsworth, B., Yardley, L., Milton, A., Weal, M. J., Smith, P. W. F., & Morrison, L. G. (2018) · Journal of Medical Internet Research · doi:10.2196/10966 · Cited by 66 · see citing works
“They may be delivered using any digital device (eg, phone and computer), making them cost-effective for providers [4,5].”
Thase, M. E., McCrone, P., Barrett, M. S., Eells, T. D., Wisniewski, S. R., Balasubramani, G. K., Brown, G. K., & Wright, J. H. (2020) · Psychotherapy and Psychosomatics · doi:10.1159/000508143 · Cited by 60 · see citing works
Digital interventions in mental health: Evidence syntheses and economic modelling
Gega, L., Jankovic, D., Saramago, P., Marshall, D., Dawson, S., Brabyn, S., Nikolaidis, G. F., Melton, H., Churchill, R., & Bojke, L. (2022) · Health Technology Assessment · doi:10.3310/rcti6942 · Cited by 48 · see citing works
Davis, E. L., Deane, F. P., Lyons, G. C., Barclay, G. D., Bourne, J., & Connolly, V. (2020) · Journal of Health Psychology · doi:10.1177/1359105317715091 · Cited by 45 · see citing works
“They have been identified in systematic reviews as both effective (Lewis et al., 2012; Musiat and Tarrier, 2014) and cost-effective (Donker et al., 2015; Musiat and Tarrier, 2014; Solomon et al., 2015) for a variety of mental health conditions.”
BackgroundA pilot evaluation of a smartphone application for workplace depression
Collins, D. A. J., Harvey, S. B., Lavender, I., Glozier, N., Christensen, H., & Deady, M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17186753 · Cited by 37 · see citing works
“Internet-delivered (eHealth) prevention programs can provide a cost-effective alternative to traditional approaches, by enabling wider dissemination and scalability of effective preventative strategies [4].”
BackgroundSangrà, P. S., Mir, S. A., Ribeiro, T. C., Esteban‐Sepúlveda, S., Pagès, E. G., López, B., Moya-Prats, J. L. P., Pintor, L., & Aguiló, J. (2021) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2021.152278 · Cited by 39 · see citing works
“Online psychological intervention strategies such as ICBT may be a promising option, together with shorter working shifts and the practice of physical exercise, as they have demonstrated evidence to strengthen mental health resilience and reduce the risk of developing psychiatric morbidities in a broad psychiatric and…”
Jankovic, D., Bojke, L., Marshall, D., Saramago Goncalves, P., Churchill, R., Melton, H., Brabyn, S., & Gega, L. (2021) · Applied Health Economics and Health Policy · doi:10.1007/s40258-020-00607-3 · Cited by 36 · see citing works
Murray, E., Ross, J., Pal, K., Li, J., Dack, C., Stevenson, F. A., Sweeting, M. J., Parrott, S., Barnard, M., Yardley, L., et al. (2018) · Programme Grants for Applied Research · doi:10.3310/pgfar06050 · Cited by 30 · see citing works
Clarke, J., Proudfoot, J., & Ma, H. (2016) · JMIR Mental Health · doi:10.2196/mental.5131 · Cited by 26 · see citing works
“Our findings suggest that myCompass, a public health intervention that is already broadly available and deliverable at minimal cost [53], may be a clinically and cost-effective and timely treatment option; a possibility that we are investigating more rigorously in a recently commenced…”
Model-Based Economic Evaluation of Treatments for Depression: A Systematic Literature Review
Kolovos, S., Bosmans, J. E., Riper, H. M., Chevreul, K., Coupé, V. M. H., & van Tulder, M. W. (2017) · PharmacoEconomics - Open · doi:10.1007/s41669-017-0014-7 · Cited by 26 · see citing works
“[96] RCTs, meta-analysis Published database, observational study Published literature Univariate and multivariate sensitivity analysis, PSA”
MethodToh, S. H. Y., Lee, S. C., & Sündermann, O. (2023) · JMIR Formative Research · doi:10.2196/45678 · Cited by 24 · see citing works
“…programs incur higher costs than web-based interventions, which, in turn, limits their scalability and feasibility in a large-scale rollout [76], mobile-based or web-based coaching sessions may be a more convenient, cost-effective, and scalable means for organizations and governments to…”
BackgroundCimino, S., Vito, P. D., & Cerniglia, L. (2022) · Current Psychology · doi:10.1007/s12144-022-03360-z · Cited by 16 · see citing works
“Even though CBT has been proven more cost-effective than other types of intervention, prior studies (Solomon et al., 2015) have argued that those costs should be further mitigated.”
Deady, M., Johnston, D. A., Glozier, N., Milne, D., Choi, I., Mackinnon, A., Mykletun, A., Calvo, R. A., Gayed, A., Bryant, R., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-020510 · Cited by 14 · see citing works
“However, the cost associated with delivering most face-to-face psychological prevention programmes has made large scale roll-outs unfeasible.(10) Consequently, most trials of MH prevention programmes have either used youth samples, where teachers and classrooms can be used to deliver faceto-face interventions, or adul…”
BackgroundSelf-citationLee, Y. Y., Mihalopoulos, C., Chatterton, M. L., Fletcher, S. L., Chondros, P., Densley, K., Murray, E., Dowrick, C. F., Coe, A., Hegarty, K. L., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0268948 · Cited by 15 · see citing works
“Intervention costs for participants in the minimal/mild prognostic group comprised the annual registration cost of an Australian unguided iCBT program [9] and the cost of research assistants providing an initial check-in phone call.”
Monitoring Mental Health Using Smart Devices with Text Analytical Tool
Alghamdi, N. S. (2019) · International Conference on Control, Decision and Information Technologies (CoDIT) · doi:10.1109/codit.2019.8820381 · Cited by 16 · see citing works
“[13, 16] They tested the efficacy of myCompass which is a psychological treatment supplied by smart devices and computers [29].”
BackgroundReeves, P., Szewczyk, Z., Proudfoot, J., Gale, N., Nicholas, J., & Anderson, J. (2019) · International Journal of Integrated Care · doi:10.5334/ijic.4157 · Cited by 15 · see citing works
“More recently, online or web-based mental health interventions have been shown to have an important role in the provision of mental health care [3, 4].”
BackgroundYoon, S., Goh, H., Low, X. C., Weng, J. H., & Heaukulani, C. (2024) · BMJ Health & Care Informatics · doi:10.1136/bmjhci-2024-101045 · Cited by 16 · see citing works
“18 Existing literature has identified the positive effects of digital mental wellness platforms on enhancing mental wellness and work-related outcomes.”
Brettschneider, C., Heddaeus, D., Steinmann, M., Härter, M. C., Watzke, B., & König, H. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02829-0 · Cited by 14 · see citing works
Davis, E. L., Deane, F. P., & Lyons, G. C. (2019) · Journal of Health Psychology · doi:10.1177/1359105316679724 · Cited by 12 · see citing works
Nilsson, A., Sörman, K., Josefin, K., Ovelius, E., Lundberg, J., & Hellner, C. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2039-1 · Cited by 13 · see citing works
Psychological interventions for asthma in children and adolescents
Sharrad, K. J., Sanwo, O., Cuevas‐Asturias, S., Kew, K. M., Carson‐Chahhoud, K., & Pike, K. C. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013420.pub2 · Cited by 14 · see citing works
Proudfoot, J. G., Clarke, J., Gunn, J. M., Fletcher, S. L., Sanatkar, S., Wilhelm, K. A., Campbell, L. V., Zwar, N. A., Harris, M., Lapsley, H., et al. (2017) · JMIR Research Protocols · doi:10.2196/resprot.7348 · Cited by 10 · see citing works
Luo, X., Bugatti, M., Molina, L., Tilley, J. L., Mahaffey, B., & Gonzalez, A. (2022) · JMIR Mental Health · doi:10.2196/35496 · Cited by 7 · see citing works
“The MyCompass program is a self-help IBI designed and shown to improve mild to moderate symptoms of depression, anxiety, and stress [20].”
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Zhang, Z., Sun, S., Moradbakhti, L., Hall, A., Mougenot, C., Chen, J., & Calvo, R. A. (2025) · JMIR Mental Health · doi:10.2196/67190 · Cited by 6 · see citing works
Sebastianski, M., Gates, M., Gates, A., Nuspl, M., Bialy, L. M., Featherstone, R. M., Breault, L. J., Mason-Lai, P., & Hartling, L. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026847 · Cited by 6 · see citing works
Psychological interventions for asthma in children and adolescents
Sharrad, K. J., Sanwo, O., Carson‐Chahhoud, K., & Pike, K. C. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013420 · Cited by 6 · see citing works
Sharrad, K. J., Kopsaftis, Z., Tai, A., Spurrier, N. J., Smith, R., Esterman, A., Gwilt, I., Stallman, H. M., & Carson‐Chahhoud, K. (2021) · International Journal of Qualitative Methods · doi:10.1177/16094069211008333 · Cited by 6 · see citing works
Patel, N., Malicka, A. N., McGinnity, S., Anderson, R. B., Paolini, A. G., & Crosland, P. (2021) · Ear and Hearing · doi:10.1097/aud.0000000000001112 · Cited by 5 · see citing works
“Internet CBT expenses are derived from per user costs of the myCompass e-CBT platform to treat depression in Australia (Solomon et al. 2015).”
BackgroundCognitive‐Behaviour Therapy and Psychological Treatments in Australia
Moulding, R., Nedeljkovic, M., & King, R. M. (2020) · Australian Psychologist · doi:10.1111/ap.12358 · Cited by 5 · see citing works
Wallace, R., Lacey, C. J., & Sargisson, R. J. (2025) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2025.102056 · Cited by 3 · see citing works
Im, J., Oh, B.-C., Song, H.-J., Choi, J., Yeo, D. H., & Lee, E. (2025) · Journal of Medical Internet Research · doi:10.2196/70248 · Cited by 2 · see citing works
The Cost-Effectiveness of Psychosocial Interventions Following Self-Harm in Australia
Krysinska, K. E., Andriessen, K., Bandara, P., Reifels, L., Flego, A., Page, A., Schlichthorst, M., Pirkis, J., Mihalopoulos, C., & Le, L. K. (2023) · Crisis · doi:10.1027/0227-5910/a000926 · Cited by 2 · see citing works
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“23,24 Again, this absence of clinician guidance means that there is a need to ensure that resources and processes are in place to support people to make informed treatment decisions independently.”
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“digital interventions for mental health, such as those delivered through smartphone apps, are becoming increasingly popular due to their accessibility, convenience, and affordability (26).”
BackgroundOnline interventions for individuals with symptoms of depression
Ocisková, M., Praško, J. P., & Holomany, J. (2024) · Psychiatrie pro praxi · doi:10.36290/psy.2024.003 · Cited by 1 · see citing works
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“For instance, systems like MyCompass [50] help users track their emotional states through journaling and biodata monitoring.”
Enhancing Depression Identification and Stratification with a Claims-Based Analytical Framework
Popkov, A. A., Barrett, T. S., Hohl, J., Shergill, A., Deakin, S., & Perry, M. (2025) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-025-09972-0
You, J. H. S., Luk, S. W. C., Chow, D. Y.-W., Mak, A. D. P., & Mak, W. W. S. (2025) · JMIR Human Factors · doi:10.2196/68167
“Similar to the present findings, the compliance rate of internet-supported CBT was also identified as the most influential factor on the cost-effectiveness of the technology-based CBT [34].”
de la Cuadra-Grande, A., Oltra-Díaz, M., de Antonio, M. L., Casado, M. Á., & Oyagüez, I. (2025) · Applied Health Economics and Health Policy · doi:10.1007/s40258-025-01022-2
- Authors
- Solomon, D., Proudfoot, J., Clarke, J., & Christensen, H.
- Affiliations
- Black Dog Institute (AU)
- Corresponding author
- Solomon, Daniela
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2015-11-11
- Volume
- 17
- Issue
- 11
- Pages
- e255
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4704984
- OpenAlex
- W2097354268
- Cited by
- 55
- References
- 65
- Citations by year
- 2025: 8 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 10 · 2019: 8 · 2018: 5 · 2017: 6 · 2016: 3
- FWCI
- 7.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Australian Government
- 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
- internet-based cognitive behavioral therapy, depression, cost-effectiveness, stepped care, antidepressants, cognitive behavioral therapy, mild to moderate depression, primary care, net monetary benefit, decision models, mental health services
- MeSH terms
- Adult, Antidepressive Agents, Australia, Cost-Benefit Analysis, Depression, Female, Humans, Male, Middle Aged, Therapy, Computer-Assisted, Internet
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