Kählke Fanny, Buntrock Claudia, Smit Filip, Berking Matthias, Lehr Dirk, Heber Elena, Funk Burkhardt, Riper Heleen, Ebert David Daniel
Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Amsterdam Public Health, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.
JMIR Ment Health. 2019 May 15;6(5):e10866. doi: 10.2196/10866.
Work-related stress is widespread among employees and associated with high costs for German society. Internet-based stress management interventions (iSMIs) are effective in reducing such stress. However, evidence for their cost-effectiveness is scant.
The aim of this study was to assess the cost-effectiveness of a guided iSMI for employees.
A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale≥22) was assigned to either the iSMI or a waitlist control condition (WLC) with unrestricted access to treatment as usual. Participants were recruited in Germany in 2013 and followed through 2014, and data were analyzed in 2017. The iSMI consisted of 7 sessions plus 1 booster session. It was based on problem-solving therapy and emotion regulation techniques. Costs were measured from the societal perspective, including all direct and indirect medical costs. We performed a cost-effectiveness analysis and a cost-utility analysis relating costs to a symptom-free person and quality-adjusted life years (QALYs) gained, respectively. Sampling uncertainty was handled using nonparametric bootstrapping (N=5000).
When the society is not willing to pay anything to get an additional symptom-free person (eg, willingness-to-pay [WTP]=€0), there was a 70% probability that the intervention is more cost-effective than WLC. This probability rose to 85% and 93% when the society is willing to pay €1000 and €2000, respectively, for achieving an additional symptom-free person. The cost-utility analysis yielded a 76% probability that the intervention is more cost-effective than WLC at a conservative WTP threshold of €20,000 (US $25,800) per QALY gained.
Offering an iSMI to stressed employees has an acceptable likelihood of being cost-effective compared with WLC.
German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/1471-2458-13-655.
工作相关压力在员工中普遍存在，给德国社会带来高昂成本。基于互联网的压力管理干预措施（iSMIs）在减轻此类压力方面有效。然而，其成本效益的证据却很少。
本研究旨在评估针对员工的一种有指导的iSMI的成本效益。
选取264名感知压力症状升高（感知压力量表≥22）的员工样本，将其分配至iSMI组或等待名单对照组（WLC），WLC组可照常无限制地获得治疗。参与者于2013年在德国招募，并随访至2014年，数据于2017年进行分析。iSMI包括7次课程加1次强化课程。它基于问题解决疗法和情绪调节技术。成本从社会角度衡量，包括所有直接和间接医疗成本。我们分别进行了成本效益分析和成本效用分析，将成本与新增无症状个体以及获得的质量调整生命年（QALYs）相关联。使用非参数自助法（N = 5000）处理抽样不确定性。
当社会不愿意为新增一名无症状个体支付任何费用时（例如，支付意愿[WTP]=0欧元），干预措施比WLC更具成本效益的概率为70%。当社会愿意为新增一名无症状个体分别支付1000欧元和2000欧元时，该概率分别升至85%和93%。在每获得一个QALY的保守支付意愿阈值为20000欧元（25800美元）时，成本效用分析得出干预措施比WLC更具成本效益的概率为76%。
与WLC相比，为压力大的员工提供iSMI具有可接受的成本效益可能性。
德国临床试验注册中心DRKS00004749；https://www.drks.de/DRKS00004749。
国际注册报告识别码（IRRID）：RR2 - 10.1186/1471 - 2458 - 13 - 655。
