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Cost–Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation

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  • Mathias Baumann

    (Universität Hamburg)

  • Tom Stargardt

    (Universität Hamburg)

  • Simon Frey

    (Universität Hamburg)

Abstract

Background and Objective Unipolar depression is the most common form of depression and demand for treatment, such as psychotherapy, is high. However, waiting times for psychotherapy often considerably exceed their recommended maximum. As a potentially less costly alternative treatment, internet-based cognitive behavior therapy (ICBT) might help reduce waiting times. We therefore analyzed the cost–utility of ICBT compared to face-to-face CBT (FCBT) as an active control treatment, taking differences in waiting time into account. Methods We constructed a Markov model to simulate costs and health outcomes measured in quality-adjusted life years (QALYs) for ICBT and FCBT in Germany. We modeled a time horizon of 3 years using six states (remission, depressed, spontaneous remission, undergoing treatment, treatment finished, death). The societal perspective was adopted. We obtained parameters for transition probabilities, depression-specific QoL, and cost data from the literature. Deterministic and probabilistic sensitivity analyses were conducted. Within a scenario analysis, we simulated different time-to-treatment combinations. Half-cycle correction was applied. Results In our simulation, ICBT generated 0.260 QALYs and saved €2536 per patient compared to FCBT. Our deterministic sensitivity analysis suggests that the base-case results were largely unaffected by parameter uncertainty and are therefore robust. Our probabilistic sensitivity analysis suggests that ICBT is highly likely to be more effective (91.5%), less costly (76.0%), and the dominant strategy (69.7%) compared to FCBT. The scenario analysis revealed that the base-case results are robust to variations in time-to-treatment differences. Conclusion ICBT has a strong potential to balance demand and supply of CBT in unipolar depression by reducing therapist time per patient. It is highly likely to generate more QALYs and reduce health care expenditure. In addition, ICBT may have further positive external effects, such as freeing up capacities for the most severely depressed patients.

Suggested Citation

  • Mathias Baumann & Tom Stargardt & Simon Frey, 2020. "Cost–Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation," Applied Health Economics and Health Policy, Springer, vol. 18(4), pages 567-578, August.
  • Handle: RePEc:spr:aphecp:v:18:y:2020:i:4:d:10.1007_s40258-019-00551-x
    DOI: 10.1007/s40258-019-00551-x
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    References listed on IDEAS

    as
    1. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    2. Nickolai Titov & Gavin Andrews & Matthew Davies & Karen McIntyre & Emma Robinson & Karen Solley, 2010. "Internet Treatment for Depression: A Randomized Controlled Trial Comparing Clinician vs. Technician Assistance," PLOS ONE, Public Library of Science, vol. 5(6), pages 1-9, June.
    3. Louise Farrer & Helen Christensen & Kathleen M Griffiths & Andrew Mackinnon, 2011. "Internet-Based CBT for Depression with and without Telephone Tracking in a National Helpline: Randomised Controlled Trial," PLOS ONE, Public Library of Science, vol. 6(11), pages 1-9, November.
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 27th July 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-07-27 11:00:01

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