title: Economic evaluation of a guided and unguided internet-based CBT intervention for major depression: Results from a multi-center, three-armed randomized controlled trial conducted in primary care.
abstract: Depression is one of the most common mental disorders and will become one of the leading causes of disability in the world. Internet-based CBT programs for depression have been classified as "well established" following the American Psychological Association criteria for empirically supported treatments. The aim of this study is to analyze the cost effectiveness at 12-month follow-up of the Internet-based CBT program "Smiling is fun" with (LITG) and without psychotherapist support (TSG) compared to usual care. The perspective used in our analysis is societal. A sample of 296 depressed patients (mean age of 43.04 years; 76% female; BDI-II mean score = 22.37) from primary care services in four Spanish regions were randomized in the RCT. The complete case and intention-to-treat (ITT) perspectives were used for the analyses. The results demonstrated that both Internet-based CBT interventions exhibited cost utility and cost effectiveness compared with a control group. The complete case analyses revealed an incremental cost-effectiveness ratio (ICER) of €-169.50 and an incremental cost-utility ratio (ICUR) of €-11389.66 for the TSG group and an ICER of €-104.63 and an ICUR of €-6380.86 for the LITG group. The ITT analyses found an ICER of €-98.37 and an ICUR of €-5160.40 for the TSG group and an ICER of €-9.91 and an ICUR of €496.72 for the LITG group. In summary, the results of this study indicate that the two Internet-based CBT interventions are appropriate from both economic and clinical perspectives for depressed patients in the Spanish primary care system. These interventions not only help patients to improve clinically but also generate societal savings.
  
  
  BACKGROUND
  clinicaltrials.gov NCT01611818.
authors.affiliation: Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital Carlos Haya, Malaga, Spain.
authors.forename: Pablo
authors.identifier: http://orcid.org/0000-0002-3683-3835
authors.initials: P
authors.lastname: Romero-Sanchiz
authors.affiliation: Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Malaga, Malaga, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Nogueira-Arjona
authors.affiliation: Chair of Health Economics and Rational Drug Use. Department of Pharmacology and Pediatrics, Faculty of Medicine, University of Malaga, Malaga, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: García-Ruiz
authors.affiliation: Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain.|Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain.
authors.forename: Juan V
authors.initials: JV
authors.lastname: Luciano
authors.affiliation: Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain.|Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain.|University Hospital Miguel Servet, Zaragoza, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: García Campayo
authors.affiliation: Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain.|IUNICS-IDISPA, University of Balearic Islands, Palma de Mallorca, Spain.
authors.forename: Margalida
authors.initials: M
authors.lastname: Gili
authors.affiliation: University Jaume I, Castellon de la Plana, Spain.|CIBER Physiopathology Obesity and Nutrition (CB06/03) Carlos III Health Institute, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Botella
authors.affiliation: CIBER Physiopathology Obesity and Nutrition (CB06/03) Carlos III Health Institute, Madrid, Spain.|University of Valencia, Valencia, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Baños
authors.affiliation: Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain.|IUNICS-IDISPA, University of Balearic Islands, Palma de Mallorca, Spain.
authors.forename: Adoración
authors.initials: A
authors.lastname: Castro
authors.affiliation: Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain.|Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain.|University of Zaragoza, Zaragoza, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: López-Del-Hoyo
authors.affiliation: Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain.|IUNICS-IDISPA, University of Balearic Islands, Palma de Mallorca, Spain.
authors.forename: Mª Ángeles
authors.initials: MÁ
authors.lastname: Pérez Ara
authors.affiliation: University of Zaragoza, Zaragoza, Spain.|Foundation Institute of Health Research of Aragon (IIS Aragon), Zaragoza, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Modrego-Alarcón
authors.affiliation: Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital Carlos Haya, Malaga, Spain.|Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain.
authors.forename: Fermín
authors.initials: F
authors.lastname: Mayoral Cleríes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000191:economics* / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011613:Psychotherapy; D012720:Severity of Illness Index; D017216:Telemedicine / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult