title: Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention.
abstract: Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders.
  
  
  
  To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression (sD).
  
  
  
  A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs).
  
  
  
  In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0.82 vs 0.70). Likewise, QALY health gains were in favor of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were €136 (£116). Taking the health care perspective and assuming a willingness-to-pay of €20,000 (£17,000), the intervention's likelihood of being cost-effective was 99% for gaining a DFY and 64% or 99% for gaining an EQ-5D or a SF-6D QALY.
  
  
  
  Our study supports guidelines recommending Web-based treatment for sD and adds that this not only restores health in people with sD, but additionally reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale.
  
  
  
  German Clinical Trials Register: DRKS00004709; http://www.drks.de/DRKS00004709 (Archived by WebCite at http://www.webcitation.org/6kAZVUxy9).
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.|EMGO+ Institute for Health and Care Research, Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands.|Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Claudia
authors.identifier: 0000-0002-4974-5455
authors.initials: C
authors.lastname: Buntrock
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.|Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Matthias
authors.identifier: 0000-0001-5903-4748
authors.initials: M
authors.lastname: Berking
authors.affiliation: EMGO+ Institute for Health and Care Research, Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands.|Trimbos Institute, Centre of Health-Economic Evaluation, Utrecht, Netherlands.|EMGO+ Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands.
authors.forename: Filip
authors.identifier: 0000-0001-9479-3600
authors.initials: F
authors.lastname: Smit
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.
authors.forename: Dirk
authors.identifier: 0000-0002-5560-3605
authors.initials: D
authors.lastname: Lehr
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.|Department for Gerontology, University of Vechta, Vechta, Germany.
authors.forename: Stephanie
authors.identifier: 0000-0001-8074-1412
authors.initials: S
authors.lastname: Nobis
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.|EMGO+ Institute for Health and Care Research, Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands.|Institute of Telepsychiatry, University of Southern Denmark, Odense, Denmark.
authors.forename: Heleen
authors.identifier: 0000-0002-8144-8901
authors.initials: H
authors.lastname: Riper
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.|EMGO+ Institute for Health and Care Research, Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands.
authors.forename: Pim
authors.identifier: 0000-0001-5497-2743
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.|Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: David
authors.identifier: 0000-0001-6820-0146
authors.initials: D
authors.lastname: Ebert
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000191:economics / Q000517:prevention & control*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D011795:Surveys and Questionnaires
keywords: Internet; cost effectiveness; early intervention; major depressive disorders; prevention