Cost Utility Analysis of Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder: Randomized Controlled Trial
BackgroundUnguided internet-based cognitive behavioral therapy (ICBT) has been proven effective for major depressive disorder (MDD). However, few studies have examined its cost-effectiveness in low-resource countries and under nonspecialist routine care. Objective...
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JMIR Publications
2025-02-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2025/1/e67567 |
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| author | Wenjing Zhou Yan Chen Herui Wu Hao Zhao Yanzhi Li Guangduoji Shi Wanxin Wang Yifeng Liu Yuhua Liao Huimin Zhang Caihong Gao Jiejing Hao Gia Han Le Roger S McIntyre Xue Han Ciyong Lu |
| author_facet | Wenjing Zhou Yan Chen Herui Wu Hao Zhao Yanzhi Li Guangduoji Shi Wanxin Wang Yifeng Liu Yuhua Liao Huimin Zhang Caihong Gao Jiejing Hao Gia Han Le Roger S McIntyre Xue Han Ciyong Lu |
| author_sort | Wenjing Zhou |
| collection | DOAJ |
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BackgroundUnguided internet-based cognitive behavioral therapy (ICBT) has been proven effective for major depressive disorder (MDD). However, few studies have examined its cost-effectiveness in low-resource countries and under nonspecialist routine care.
ObjectiveThis study aimed to evaluate the short- and long-term cost utility of unguided ICBT compared to a waitlist control for persons with MDD from the perspectives of society and the health care system.
MethodsThis analysis was implemented alongside an 8-week 2-arm randomized controlled trial with a 12-month follow-up period conducted in Shenzhen, China. Outcomes including cost and health utility were collected at the pretreatment and posttreatment time points and 3, 6, and 12 months after the intervention. Direct medical costs and indirect costs were prospectively collected using the hospital information system and the Sheehan Disability Scale. Health outcomes were measured using the Chinese version of the Short-Form Six-Dimension health index. The primary outcome was incremental cost utility ratio (ICUR) expressed as the difference in costs between 2 therapies by the difference in quality-adjusted life years (QALYs). The seemingly unrelated regression model and the bootstrap method were performed to estimate adjusted ICURs. Cost-effectiveness planes and cost-effectiveness acceptability curves were used to demonstrate uncertainty. A series of scenario analyses were conducted to verify the robustness of base-case results.
ResultsIn total, 244 participants with MDD were randomly allocated to the ICBT (n=122, 50%) or waitlist control (n=122, 50%) groups. At the pretreatment time point, no statistically significant difference was observed in direct medical cost (P=.41), indirect cost (P=.10), or health utility (P=.11) between the 2 groups. In the base-case analysis, the ICBT group reported higher direct medical costs and better quality of life but lower total costs at the posttreatment time point. The adjusted ICURs at the posttreatment time point were CN ¥–194,720.38 (US $–26,551.50; 95% CI CN ¥–198,766.78 to CN ¥–190,673.98 [US $–27,103.20 to US $–25,999.70]) and CN ¥49,700.33 (US $6776.99; 95% CI CN ¥46,626.34-CN ¥52,774.31 [US $6357.83-$7196.15]) per QALY from the societal and health care system perspectives, respectively, with a probability of unguided ICBT being cost-effective of 75.93% and 54.4%, respectively, if the willingness to pay was set at 1 time the per-capita gross domestic product. In the scenario analyses, the probabilities increased to 76.85% and 77.61%, respectively, indicating the potential of ICBT to be cost-effective over the long term.
ConclusionsUnguided ICBT is a cost-effective treatment for MDD. This intervention not only helps patients with MDD improve clinically but also generates societal savings. These findings provide health economic evidence for a potential scalable MDD treatment method in low- and middle-income countries.
Trial RegistrationChinese Clinical Trial Registry (ChiCTR) ChiCTR2100046425; https://tinyurl.com/bdcrj4zv |
| format | Article |
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| institution | DOAJ |
| issn | 1438-8871 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | JMIR Publications |
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| series | Journal of Medical Internet Research |
| spelling | doaj-art-1af3bb2c6a1447e69cb0a44af74d367d2025-08-20T03:11:48ZengJMIR PublicationsJournal of Medical Internet Research1438-88712025-02-0127e6756710.2196/67567Cost Utility Analysis of Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder: Randomized Controlled TrialWenjing Zhouhttps://orcid.org/0009-0006-3211-1081Yan Chenhttps://orcid.org/0000-0001-6517-6398Herui Wuhttps://orcid.org/0009-0004-2130-6743Hao Zhaohttps://orcid.org/0000-0002-8799-8533Yanzhi Lihttps://orcid.org/0000-0001-7436-2440Guangduoji Shihttps://orcid.org/0000-0001-5551-6176Wanxin Wanghttps://orcid.org/0000-0003-4979-9514Yifeng Liuhttps://orcid.org/0000-0002-8096-1885Yuhua Liaohttps://orcid.org/0000-0002-5006-6644Huimin Zhanghttps://orcid.org/0000-0001-5944-400XCaihong Gaohttps://orcid.org/0009-0006-3080-399XJiejing Haohttps://orcid.org/0009-0009-2609-5769Gia Han Lehttps://orcid.org/0000-0001-6457-0086Roger S McIntyrehttps://orcid.org/0000-0003-4733-2523Xue Hanhttps://orcid.org/0000-0003-2052-9545Ciyong Luhttps://orcid.org/0000-0003-4266-4967 BackgroundUnguided internet-based cognitive behavioral therapy (ICBT) has been proven effective for major depressive disorder (MDD). However, few studies have examined its cost-effectiveness in low-resource countries and under nonspecialist routine care. ObjectiveThis study aimed to evaluate the short- and long-term cost utility of unguided ICBT compared to a waitlist control for persons with MDD from the perspectives of society and the health care system. MethodsThis analysis was implemented alongside an 8-week 2-arm randomized controlled trial with a 12-month follow-up period conducted in Shenzhen, China. Outcomes including cost and health utility were collected at the pretreatment and posttreatment time points and 3, 6, and 12 months after the intervention. Direct medical costs and indirect costs were prospectively collected using the hospital information system and the Sheehan Disability Scale. Health outcomes were measured using the Chinese version of the Short-Form Six-Dimension health index. The primary outcome was incremental cost utility ratio (ICUR) expressed as the difference in costs between 2 therapies by the difference in quality-adjusted life years (QALYs). The seemingly unrelated regression model and the bootstrap method were performed to estimate adjusted ICURs. Cost-effectiveness planes and cost-effectiveness acceptability curves were used to demonstrate uncertainty. A series of scenario analyses were conducted to verify the robustness of base-case results. ResultsIn total, 244 participants with MDD were randomly allocated to the ICBT (n=122, 50%) or waitlist control (n=122, 50%) groups. At the pretreatment time point, no statistically significant difference was observed in direct medical cost (P=.41), indirect cost (P=.10), or health utility (P=.11) between the 2 groups. In the base-case analysis, the ICBT group reported higher direct medical costs and better quality of life but lower total costs at the posttreatment time point. The adjusted ICURs at the posttreatment time point were CN ¥–194,720.38 (US $–26,551.50; 95% CI CN ¥–198,766.78 to CN ¥–190,673.98 [US $–27,103.20 to US $–25,999.70]) and CN ¥49,700.33 (US $6776.99; 95% CI CN ¥46,626.34-CN ¥52,774.31 [US $6357.83-$7196.15]) per QALY from the societal and health care system perspectives, respectively, with a probability of unguided ICBT being cost-effective of 75.93% and 54.4%, respectively, if the willingness to pay was set at 1 time the per-capita gross domestic product. In the scenario analyses, the probabilities increased to 76.85% and 77.61%, respectively, indicating the potential of ICBT to be cost-effective over the long term. ConclusionsUnguided ICBT is a cost-effective treatment for MDD. This intervention not only helps patients with MDD improve clinically but also generates societal savings. These findings provide health economic evidence for a potential scalable MDD treatment method in low- and middle-income countries. Trial RegistrationChinese Clinical Trial Registry (ChiCTR) ChiCTR2100046425; https://tinyurl.com/bdcrj4zvhttps://www.jmir.org/2025/1/e67567 |
| spellingShingle | Wenjing Zhou Yan Chen Herui Wu Hao Zhao Yanzhi Li Guangduoji Shi Wanxin Wang Yifeng Liu Yuhua Liao Huimin Zhang Caihong Gao Jiejing Hao Gia Han Le Roger S McIntyre Xue Han Ciyong Lu Cost Utility Analysis of Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder: Randomized Controlled Trial Journal of Medical Internet Research |
| title | Cost Utility Analysis of Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder: Randomized Controlled Trial |
| title_full | Cost Utility Analysis of Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder: Randomized Controlled Trial |
| title_fullStr | Cost Utility Analysis of Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder: Randomized Controlled Trial |
| title_full_unstemmed | Cost Utility Analysis of Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder: Randomized Controlled Trial |
| title_short | Cost Utility Analysis of Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder: Randomized Controlled Trial |
| title_sort | cost utility analysis of internet based cognitive behavioral therapy for major depressive disorder randomized controlled trial |
| url | https://www.jmir.org/2025/1/e67567 |
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