Cost-effectiveness of Internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms

Type of funding sources: Public hospital(s). Main funding source(s): The Swedish Research Council and the Medical Research of Southeast Sweden

Cost-effectiveness evaluations of psychological interventions, such as Internet-delivered cognitive behavioural therapy (iCBT) programs, in patients with cardiovascular disease (CVD) are rare. In a recent study we reported that a 9-week iCBT program (n=72) compared to an online discussion forum (ODF) (n=72) had moderate to large effect on depression in CVD outpatients.

To evaluate the cost-effectiveness of this intervention.

Cost-effectiveness analysis of a RCT, using an incremental cost-effectiveness ratio (ICER). The costs and effects included in the ICER are from baseline to one year post intervention, but also costs for guidance and support to patients in iCBT and ODF groups. Data on healthcare costs were retrieved from healthcare registries, and the EQ-5D-3L was used to calculate the quality-adjusted life years (QALYs). The ICER can be seen as the additional costs needed to gain an additional QALY by the iCBT compared to ODF.

At 12-month follow-up, the QALY was significantly higher in iCBT compared to the ODF group (0.713 vs.0.598, p=.007). The mean difference of 0.115 corresponds with 42 extra days in best imaginable health status in favour of the iCBT group over the course of one year. The ICER for iCBT versus ODF was €18,865 per QALY saved. The cost-effectiveness plane indicated that iCBT is a cheaper and more effective intervention in 24.5% of the cases, and in 75% a costlier and more effective intervention than ODF. Only in about 0.5% of the cases, there was an indication of a costlier, but less effective intervention compared to ODF.

The ICER of €18,865 was lower than the cost-effectiveness threshold range of €23,400-€35,100 as proposed by the NICE guidelines, suggesting that the iCBT treatment of depressive symptoms in patients with CVD is cost-effective.