Kählke F, Buntrock C, Smit F, Ebert DD. Systematic review of economic evaluations for internet- and mobile-based interventions for mental health problems. npj Digit. Med. 5, 175 (2022). https://doi.org/10.1038/s41746-022-00702-w
A systematic review was conducted to summarize the cost-effectiveness of internet and mobile-based interventions (IMIs) for mental health disorders and symptoms. This review also assessed methodological quality of included studies. The literature search identified studies of psychological interventions provided in an online setting to treat mental health disorders or any type of psychological symptoms regardless of participant age. Studies had to be randomized controlled trials that included a full economic evaluation. A total of 4,044 articles were identified, of which 36 articles met eligibility criteria. Sixty-five economic evaluations were conducted. The most commonly targeted mental health problem was major depressive disorder or depressive symptoms, followed by anxiety. Cost-effectiveness was determined using the threshold of at or below £30,000 per quality-adjusted life year (QALY) gained. Overall, the majority of economic evaluations of IMIs (n=56) presented evidence of cost-effectiveness. Guided IMIs (i.e., interventions that include support by a provider via email, chat, or automated feedback delivery) were likely to be cost-effective in depression and anxiety studies. Methodological quality of the cost-effectiveness analyses was mostly evaluated as good, however a few studies showed high risk of bias. Researchers found high heterogeneity across studies due to factors such as costing methods, design, comparators, and outcomes used. Overall, these findings suggest the cost-effectiveness of IMIs and include new evidence in under-researched disorders such as obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), stress, and sleep. Future research is needed to continue to target underrepresented disorders (e.g., panic disorder and specific phobias), as well as research in low- and middle-income countries.