OBJECTIVES: This study assessed the programmatic costs of web-based adolescent depression intervention programs necessary to meet a $0 net cost and $100,000/QALY cost-effectiveness threshold from a US payer perspective.
METHODS: A Markov model was developed to evaluate five web-based adolescent depression intervention programs, identified in a systematic review: Competent Adulthood Transition with Cognitive, Behavioral, Humanistic, and Interpersonal Training (CATCHIT); the Depression-Alcohol Project (DEAL); Grasping the Opportunity (GRASP); Master your Mood (MYM); and Solution-Focused Brief Therapy (SFBT). Each intervention was evaluated against the comparator from the respective clinical trial. One program (CATCHIT) was evaluated against an active comparator, potentially reducing the observed effect size and cost-effectiveness. The Markov states were: “no depression”, “mild depression”, “severe depression”, and “death”. Severe depression, suicidal ideation and suicide attempt were modeled as transition states. The cycle length was one month and the time horizon varied by the length of each clinical trial. Depression-related costs and utilities were identified through a systematic review of the literature.
RESULTS: The monthly intervention cost to meet $100,000/QALY suggested the following: $41 (CATCHIT), $270 (DEAL), $105 (GRASP), $406 (MYM), and $458 (SFBT). The monthly intervention cost to meet $0 net cost suggested: $8 per month (CATCHIT), $50 (DEAL), $20 (GRASP), $75 (MYM), and $86 (SFBT).
CONCLUSIONS: Our study is the first to suggest cost-effectiveness evidence for online, evidence-based depression prevention programs. Web-based programs are typically not covered by payers, but can be justified if effective and delivered in a cost-effective manner. It is likely that the programs in this analysis can be delivered below the monthly cost to meet the cost-effectiveness threshold of $100,000/QALY.
