@Article{info:doi/10.2196/36496,
author="Chatterton, Mary Lou
and Lee, Yong Yi
and Berk, Lesley
and Mohebbi, Mohammadreza
and Berk, Michael
and Suppes, Trisha
and Lauder, Sue
and Mihalopoulos, Cathrine",
title="Cost-Utility and Cost-effectiveness of MoodSwings 2.0, an Internet-Based Self-management Program for Bipolar Disorder: Economic Evaluation Alongside a Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2022",
month="Nov",
day="1",
volume="9",
number="11",
pages="e36496",
keywords="economic evaluation; cost-effectiveness; cost-utility; clinical trial; bipolar disorder; psychoeducation; cognitive behavioral therapy; internet intervention; mania; depression; psychiatry; neuroscience; mental disorders",
abstract="Background: Internet-delivered psychosocial interventions can overcome barriers to face-to-face psychosocial care, but limited evidence supports their cost-effectiveness for people with bipolar disorders (BDs). Objective: This study aimed to conduct within-trial cost-effectiveness and cost-utility analyses of an internet-based intervention for people with BD, MoodSwings 2.0, from an Australian health sector perspective. Methods: MoodSwings 2.0 included an economic evaluation alongside an international, parallel, and individually stratified randomized controlled trial comparing an internet-based discussion forum (control; group 1), a discussion forum plus internet-based psychoeducation (group 2), and a discussion forum plus psychoeducation and cognitive behavioral tools (group 3). The trial enrolled adults (aged 21 to 65 years) with a diagnosis of BD assessed by telephone using a structured clinical interview. Health sector costs included intervention delivery and additional health care resources used by participants over the 12-month trial follow-up. Outcomes included depression symptoms measured by the Montgomery-{\AA}sberg Depression Rating Scale (MADRS; the trial primary outcome) and quality-adjusted life years (QALYs) calculated using the short-form 6-dimension instrument derived from the 12-item version of the short-form health survey. Average incremental cost-effectiveness (cost per MADRS score) and cost-utility (cost per QALY) ratios were calculated using estimated mean differences between intervention and control groups from linear mixed effects models in the base case. Results: In total, 304 participants were randomized. Average health sector cost was lowest for group 2 (Aus {\$}9431, SD Aus {\$}8540; Aus {\$}1=US {\$}0.7058) compared with the control group (Aus {\$}15,175, SD Aus {\$}17,206) and group 3 (Aus {\$}15,518, SD Aus {\$}30,523), but none was statistically significantly different. The average QALYs were not significantly different among the groups (group 1: 0.627, SD 0.062; group 2: 0.618, SD 0.094; and group 3: 0.622, SD 0.087). The MADRS scores were previously shown to differ significantly between group 2 and the control group at all follow-up time points (P<.05). Group 2 was dominant (lower costs and greater effects) compared with the control group for average incremental cost per point decrease in MADRS score over 12 months (95{\%} CI dominated to Aus {\$}331). Average cost per point change in MADRS score for group 3 versus the control group was dominant (95{\%} CI dominant to Aus {\$}22,585). Group 2 was dominant (95{\%} CI Aus {\$}43,000 to dominant) over the control group based on lower average health sector cost and average QALY benefit of 0.012 (95{\%} CI --0.009 to 0.033). Group 3, compared with the control group, had an average incremental cost-effectiveness ratio of dominant (95{\%} CI dominated to Aus {\$}19,978). Conclusions: Web-based psychoeducation through MoodSwings 2.0 has the potential to be a cost-effective intervention for people with BD. Additional research is needed to understand the lack of effectiveness for the addition of cognitive behavioral tools with the group 3 intervention. ",
issn="2368-7959",
doi="10.2196/36496",
url="https://mental.jmir.org/2022/11/e36496",
url="https://doi.org/10.2196/36496",
url="http://www.ncbi.nlm.nih.gov/pubmed/36318243"
}