Abstract
BackgroundDepression often remains undiagnosed or treated inadequately. Web-based interventions for depression may improve accessibility of treatment and reduce disease-related costs. This study aimed to examine the potential of the web-based cognitive behavioral intervention “deprexis” in reducing disease-related costs.MethodsParticipants with mild to moderate depressive symptoms were recruited and randomized to either a 12-week web-based intervention (deprexis) in addition to care as usual (intervention group) or care as usual (control group). Outcome measures were health-related resource use, use of medication and incapacity to work as well as relating direct health care costs. Outcomes were assessed on patients’ self-report at baseline, three months and six months.ResultsA total of 1013 participants were randomized. In both groups total direct health care costs decreased during the study period, but changes from baseline did not significantly differ between study groups. Numeric differences between study groups existed in outpatient treatment costs. They could be attributed to differences in changes of costs for psychotherapeutic treatment from baseline. Whereas costs for psychotherapeutic treatment decreased in the intervention group, costs increased in the control group (− 16.8% (€80) vs. + 14.7% (€60)) (tdf = 685 = 2.57; p = 0.008).ConclusionThe study indicates the health economic potential of innovative e-mental-health programs. There is evidence to suggest that the use of deprexis over a period of 12 weeks leads to a decrease in outpatient treatment cost, especially in those related to different types of psychotherapeutic treatment.
Highlights
Depression often remains undiagnosed or treated inadequately
Most of them were excluded because they reached a score on Patient Health Questionnaire (PHQ)-9 of 14 points or more (n = 748; 74.3%)
Whereas costs for psychotherapeutic treatment decreased in the intervention group by 16.8% (€80) during the period of six months post enrollment to the study, costs increased in the control group by 14.7% (€60)
Summary
Web-based interventions for depression may improve accessibility of treatment and reduce disease-related costs. Many individuals with depression remain untreated, even in countries with well-developed health care systems [13]. This globally documented treatment gap in the management of mental illnesses may be counteracted by internet based self-help interventions. This form of intervention is relevant as a treatment of mild to moderate depression [14, 15]. Employed in a stepped-care model, low intensity online-based interventions may bridge the treatment gap as an appropriate first option for patients with mild to moderate depressive symptoms. Advantages are low threshold, local and temporal independence, reductions in waiting time for face-to-face treatment, empowerment and anonymity [15, 16]
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