Cost-effectiveness of Internet Interventions Compared With Treatment as Usual for People With Mental Disorders: Systematic Review and Meta-analysis of Randomized Controlled Trials.

Autor:	Rohrbach PJ; GGZ Rivierduinen Eating Disorders Ursula, Leiden, Netherlands.; Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands., Dingemans AE; GGZ Rivierduinen Eating Disorders Ursula, Leiden, Netherlands., Evers C; Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, Netherlands., Van Furth EF; GGZ Rivierduinen Eating Disorders Ursula, Leiden, Netherlands.; Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands., Spinhoven P; Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands.; Institute of Psychology, Leiden University, Leiden, Netherlands., Aardoom JJ; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands., Lähde I; GGZ Rivierduinen Eating Disorders Ursula, Leiden, Netherlands., Clemens FC; GGZ Rivierduinen Eating Disorders Ursula, Leiden, Netherlands., Van den Akker-Van Marle ME; Section of Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands.
Jazyk:	angličtina
Zdroj:	Journal of medical Internet research [J Med Internet Res] 2023 Jan 05; Vol. 25, pp. e38204. Date of Electronic Publication: 2023 Jan 05.
DOI:	10.2196/38204
Abstrakt:	Background: The economic costs of mental disorders for society are huge. Internet-based interventions are often coined as cost-effective alternatives to usual care, but the evidence is mixed. Objective: The aim was to review the literature on the cost-effectiveness of internet interventions for mental disorders compared with usual care and to provide an estimate of the monetary benefits of such interventions compared with usual care. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted, which included participants with symptoms of mental disorders; investigated a telephone- or internet-based intervention; included a control condition in the form of treatment as usual, psychological placebo, waiting list control, or bibliotherapy; reported outcomes on both quality of life and costs; and included articles published in English. Electronic databases such as PubMed (including MEDLINE), Embase, Emcare, PsycINFO, Web of Science, and the Cochrane Library were used. Data on risk of bias, quality of the economic evaluation, quality-adjusted life years, and costs were extracted from the included studies, and the incremental net benefit was calculated and pooled. Results: The search yielded 6226 abstracts, and 37 studies with 14,946 participants were included. The quality of economic evaluations of the included studies was rated as moderate, and the risk of bias was high. A random-effects approach was maintained. Analyses suggested internet interventions were slightly more effective than usual care in terms of quality-adjusted life years gain (Hedges g=0.052, 95% CI 0.010-0.094; P=.02) and equally expensive (Hedges g=0.002, 95% CI -0.080 to 0.84; P=.96). The pooled incremental net benefit was US $255 (95% CI US $91 to US $419; P=.002), favoring internet interventions over usual care. The perspective of the economic evaluation and targeted mental disorder moderated the results. Conclusions: The findings indicate that the cost-effectiveness of internet interventions for mental disorders compared with a care-as-usual approach is likely, but generalizability to new studies is poor given the substantial heterogeneity. This is the first study in the field of mental health to pool cost-effectiveness outcomes in an aggregate data meta-analysis. Trial Registration: PROSPERO CRD42019141659; https://tinyurl.com/3cu99b34. (©Pieter J Rohrbach, Alexandra E Dingemans, Catharine Evers, Eric F Van Furth, Philip Spinhoven, Jiska J Aardoom, Irene Lähde, Fleur C Clemens, M Elske Van den Akker-Van Marle. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 05.01.2023.)
Databáze:	MEDLINE
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