Preventing depression in adults with subthreshold depression: Health-economic evaluation alongside a pragmatic randomized controlled trial of a web-based intervention.

07/07/2017

Buntrock C, Berking M, Smit F, et al. (2017). Preventing depression in adults with subthreshold depression: Health-economic evaluation alongside a pragmatic randomized controlled trial of a web-based intervention. Journal of Medical Internet Research. 19(1): e5. doi: 10.2196/jmir.6587

Researchers evaluated the cost-effectiveness of an internet-based intervention for preventing major depressive disorder (MDD) in adults with subthreshold depression compared to enhanced usual care (EUC). During a pragmatic randomized controlled trial, 406 participants were recruited using referrals from an insurance company and advertisements. Participants were randomized into a group that received access to a self-guided, six session internet-based intervention (GET.ON Mood Enhancer Prevention) or to a control group that received usual care and psychoeducation. Researchers evaluated depression free years (DFYs), quality adjusted life years (QALYs), and the costs associated with psychiatric illness (i.e. productivity losses, health care utilization, the intervention, care from family and friends, and travel) to determine the cost effectiveness of the intervention. Participants completed assessments of quality of life at baseline, six weeks after baseline (end of treatment), six months after baseline, and 12 months after baseline. The improvement in DFYs between the intervention and control groups was significant. Participants in the intervention group also experienced greater improvements in QALYs during the assessment period compared to the control group. The intervention cost more than enhanced usual care and improvements in health outcomes are achieved at a higher cost than EUC. The cost-effectiveness of the intervention depends on society’s willingness to pay for improvements in wellbeing and the likelihood of the intervention being cost-effective rises as society’s willingness to pay rises.