Internet Based Treatment of Depressive Symptoms – A Health Economic Evaluation of Costs and Benefits

Abstract

Despite differentiated guidelines, depressive episodes often stay undiagnosed or are treated inadequately. Online-based self-help-, consulting- and treatment-services may reduce deficits in treating depressive disorders and reduce disease-related costs. This study aimed to examine the potential of the internet-based cognitive behavioural therapy “deprexis” to reduce total costs of statutory health insurance. Secondary, changes in depression severity, health-related quality of life and impairment in functioning were examined. Participants with mild to moderate depressive symptoms were recruited from a huge German sickness fund and randomized to either a 12-week internet intervention (deprexis) or care as usual (CAU). The primary outcome measure was costs of statutory health insurance (excluding outpatient costs), secondary outcomes were depression severity (PHQ-9), health-related quality of life (SF-12 and EQ-5D-3L) and impairment in functioning (Work and Social Adjustment Scale). Outcomes were assessed at baseline, three months and six months, using an online based questionnaire. Additionally, health insurers’ administrative data were included in the analyses. A total of 3.806 participants were randomized. In both groups, total costs of statutory health insurance decreased during the study period, but the changes from baseline differed significantly between groups. In the intervention group the total costs decreased by 32% from 3.139€ per year at baseline to 2.119€ in the study year (vs. a mean reduction in total costs of 13% in CAU-group; p<0.002). In comparison to the CAU-group, the intervention group also showed a significant greater reduction in PHQ-9, a significant greater decrease in impairment in functioning and a significant greater increase in health-related quality of life. The study underlines the potential of innovative e-mental-health programs in treating depressive disorders. The results suggest that the use of deprexis over a period of 12 weeks leads to a significant improvement of symptoms with a simultaneous reduction in cost of statutory health insurance.