@article{77cb72c7299a4a32b02a285568d94ed8,
title = "Internet- and mobile-based intervention for depression in adults with chronic back pain: A health economic evaluation",
abstract = "Background: Depression and comorbid chronic back pain (CBP) lead to high personal and economic burden. Internet- and mobile-based interventions (IMI) might be a cost-effective adjunct to established interventions. Methods: A health economic evaluation was embedded into an observer-blinded, multicenter RCT (societal and health care perspective). We randomly assigned participants (≥18 years) with CBP and diagnosed depression from 82 orthopedic clinics across Germany to intervention (IG + treatment as usual [TAU]) or TAU control group (CG). The IG received a guided IMI. Primary outcomes were depression response and quality-adjusted life years (QALYs) at 6-months follow-up. Multiple imputation was used to address missing data. Incremental cost-effectiveness/cost-utility ratios (ICER/ICUR) and the probability of being cost-effective at different willingness-to-pay thresholds were calculated. Statistical uncertainty was estimated using bootstrapping techniques (N = 10,000). Results: Between October 2015 and July 2017 210 participants were randomly assigned to IG (n = 105) and CG (n = 105). Depression response did not differ significantly between groups. QALYs were significantly higher in the IG compared to the CG. Taking the societal perspective and assuming a commonly used willingness-to-pay of €34,000/QALY, the intervention's likelihood of being cost-effective was 64%. Limitations: The main limitation is that the study was powered to detect clinical but not health economic differences between groups. Conclusion: The IMI is considered cost-effective (vs. CG) for individuals with depression and CBP (societal perspective). These results are promising when considering the high individual and economic burden of this patient group. Further research is needed to adequately inform political decision makers before implementation into routine care.",
keywords = "Chronic pain, Comorbidity, Cost-effectiveness, Cost-utility, Depressive disorder, E-Health",
author = "Sarah Paganini and Yannik Terhorst and Sander, {Lasse Bosse} and Jiaxi Lin and Sandra Schlicker and Ebert, {David Daniel} and Matthias Berking and Heleen Riper and Harald Baumeister",
note = "Funding Information: We thank our many study assistants for their support in recruitment and data processing. We thank Maren Clarissa K?hler and Amelie Schlawinsky for their support in data analysis and literature research for the manuscript. Many thanks go to Claudia Buntrock and Fanny K?hlke for sharing their expertise in health economic evaluations. We thank Ellen Meierotto for supervising the SCID interviewers. Many thanks go to the Data Safety and Monitoring Board, consisting of Prof Dr. Martin Hautzinger, Prof Dr. Martin H?rter and Dr. Levente Kriston as well as the Clinical Trials Unit Freiburg for their support in carrying out the study project. Special thanks go to the cooperating orthopedic rehabilitation clinics Schoen Klinik, Bad Staffelstein; Rehaklinik Sonnhalde, Donaueschingen; RehaKlinikum Bad S?ckingen; St?dt. Rehakliniken Bad Waldsee; Schwarzwaldklinik Orthop?die - Abteilung Medizinische Rehabilitation, Bad Krozingen; Rheintalklinik Bad Krozingen; REGIO-Reha Tagesklinik, Freiburg and Universit?ts- und Rehabilitationskliniken, Ulm as well as all orthopedic rehabilitation clinics participating in the second recruitment wave. This study was funded by the German Federal Ministry of Education and Research (project ?Effectiveness of a guided web-based intervention for depression in back pain rehabilitation aftercare?, grant number: 01GY1330A; 01GY1330B). The funders had no role in the study design, data collection and analysis, the decision to publish or in the preparation of the manuscript. The views expressed are those of the author(s) and not necessarily those of the funder. Funding Information: LBS and SaS have received payments for workshops on e-mental-health. HB received consultancy fees, reimbursement of congress attendance and travel costs as well as payments for lectures from Psychotherapy and Psychiatry Associations as well as Psychotherapy Training Institutes in the context of E-Mental-Health topics. He has been the beneficiary of study support (third-party funding) from several public funding organizations. DDE and MB possess shares in the GET. On Institut GmbH, which works to transfer research findings on Internet- and mobile-phone-based health interventions into routine care. DDE has received payments from several companies and health insurance providers for advice on the use of internet-based interventions. He has received payments for lectures from Psychotherapy and Psychiatry Associations and has been the beneficiary of third-party funding from health insurance providers. DDE and MB were not involved in the data analysis. Publisher Copyright: {\textcopyright} 2022 Elsevier B.V.",
year = "2022",
month = jul,
day = "1",
doi = "https://doi.org/10.1016/j.jad.2022.04.004",
language = "English",
volume = "308",
pages = "607--615",
journal = "Journal of affective disorders",
issn = "0165-0327",
publisher = "Elsevier",
}