• Elin Lindsäter, Erland Axelsson, Sigrid Salomonsson, Fredrik Santoft, Brjánn Ljótsson, Torbjörn Åkerstedt, Mats Lekander, and Erik Hedman-Lagerlöf.
• Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
• J. Med. Internet Res. 2019 Sep 13; 21 (9): e14675.

BackgroundStress-related disorders are associated with significant suffering, functional impairment, and high societal costs. Internet-based cognitive behavioral therapy (ICBT) is a promising treatment for stress-related disorders but has so far not been subjected to health economic evaluation.ObjectiveThe objective of this study was to evaluate the cost-effectiveness and cost-utility of ICBT for patients with stress-related disorders in the form of adjustment disorder (AD) or exhaustion disorder (ED). We hypothesized that ICBT, compared with a waitlist control (WLC) group, would generate improvements at low net costs, thereby making it cost-effective.MethodsHealth economic data were obtained in tandem with a randomized controlled trial of a 12-week ICBT in which patients (N=100) were randomized to an ICBT (n=50) or a WLC (n=50) group. Health outcomes and costs were surveyed pre- and posttreatment. We calculated incremental cost-effectiveness ratios (ICERs) based on remission rates and incremental cost-utility ratios (ICURs) based on health-related quality of life. Bootstrap sampling was used to assess the uncertainty of our results.ResultsThe ICER indicated that the most likely scenario was that ICBT led to higher remission rates compared with the WLC and was associated with slightly larger reductions in costs from pre- to posttreatment. ICBT had a 60% probability of being cost-effective at a willingness to pay (WTP) of US $0 and a 96% probability of being cost-effective at a WTP of US $1000. The ICUR indicated that ICBT also led to improvements in quality of life at no net societal cost. Sensitivity analyses supported the robustness of our results.ConclusionsThe results suggest that ICBT is a cost-effective treatment for patients suffering from AD or ED. Compared with no treatment, ICBT for these patients yields large effects at no or minimal societal net costs.Trial RegistrationClinicalTrials.gov NCT02540317; https://clinicaltrials.gov/ct2/show/NCT02540317.©Elin Lindsäter, Erland Axelsson, Sigrid Salomonsson, Fredrik Santoft, Brjánn Ljótsson, Torbjörn Åkerstedt, Mats Lekander, Erik Hedman-Lagerlöf. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.09.2019.

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