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Economic evaluations of Internet interventions for mental health: a systematic review

Published online by Cambridge University Press:  03 August 2015

T. Donker ,
M. Blankers ,
E. Hedman ,
B. Ljótsson ,
K. Petrie  and
H. Christensen
T. Donker*
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands The Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
M. Blankers
Affiliation:
Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
E. Hedman
Affiliation:
Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
B. Ljótsson
Affiliation:
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
K. Petrie
Affiliation:
The Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
H. Christensen
Affiliation:
The Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
*
*Address for correspondence: T. Donker, PhD, Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: [email protected])
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Abstract

Background.

Internet interventions are assumed to be cost-effective. However, it is unclear how strong this evidence is, and what the quality of this evidence is.

Method.

A comprehensive literature search (1990–2014) in Medline, EMBASE, the Cochrane Central Register of Controlled Trials, NHS Economic Evaluations Database, NHS Health Technology Assessment Database, Office of Health Economics Evaluations Database, Compendex and Inspec was conducted. We included economic evaluations alongside randomized controlled trials of Internet interventions for a range of mental health symptoms compared to a control group, consisting of a psychological or pharmaceutical intervention, treatment-as-usual (TAU), wait-list or an attention control group.

Results.

Of the 6587 abstracts identified, 16 papers met the inclusion criteria. Nine studies featured a societal perspective. Results demonstrated that guided Internet interventions for depression, anxiety, smoking cessation and alcohol consumption had favourable probabilities of being more cost-effective when compared to wait-list, TAU, group cognitive behaviour therapy (CBGT), attention control, telephone counselling or unguided Internet CBT. Unguided Internet interventions for suicide prevention, depression and smoking cessation demonstrated cost-effectiveness compared to TAU or attention control. In general, results from cost-utility analyses using more generic health outcomes (quality of life) were less favourable for unguided Internet interventions. Most studies adhered reasonably to economic guidelines.

Conclusions.

Results of guided Internet interventions being cost-effective are promising with most studies adhering to publication standards, but more economic evaluations are needed in order to determine cost-effectiveness of Internet interventions compared to the most cost-effective treatment currently available.

Keywords

anxietycost-effectivenessdepressionInternet interventionssubstance abusesuicidal behaviour
Type
Review Article
Information
Psychological Medicine , Volume 45 , Issue 16 , December 2015 , pp. 3357 - 3376
Copyright
Copyright © Cambridge University Press 2015 

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