Format
Scientific article
Publication Date
Published by / Citation
Abi Hana R, Abi Ramia J, Burchert S, Carswell K, Cuijpers P, Heim E, Knaevelsrud C, Noun P, Sijbrandij M, van Ommeren M, Van't Hof E, Wijnen B, Zoghbi E, El Chammay R, Smit F. Cost-Effectiveness of Digital Mental Health Versus Usual Care During Humanitarian Crises in Lebanon: Pragmatic Randomized Trial. JMIR Ment Health. 2024 May 29;11:e55544. doi: 10.2196/55544. PMID: 38810255; PMCID: PMC11170045.
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Keywords
Cost-Effectiveness
depression
mental health
Digital Health

Cost-Effectiveness of Digital Mental Health Versus Usual Care During Humanitarian Crises in Lebanon: Pragmatic Randomized Trial

Background:
Digital mental health interventions for depression, anxiety, and stress-related disorders are generally cost-effective, but evidence is lacking for guided digital mental health care in low and middle-income countries (LMICs) facing humanitarian crises. Step-by-Step (SbS) is effective for Lebanese citizens and war-affected Syrians in Lebanon. Assessing SbS's cost-effectiveness is crucial due to Lebanon's strained health care system.

Objective:
This study aims to assess the cost-effectiveness of SbS compared to enhanced usual care (EUC) through a randomized trial.

Methods:
A cost-effectiveness analysis was conducted with 614 participants receiving SbS and 635 receiving EUC. The primary outcome was cost per treatment response (>50% reduction in depressive symptoms). The secondary outcome was cost per remission (PHQ score <5 at 5 months). The evaluation was conducted from health care and societal perspectives.

Results:
From the health care perspective, SbS had an 80% probability of being cost-effective compared to EUC, with a willingness to pay US $220 per additional treatment response or US $840 per additional remission. From the societal perspective, SbS had a >75% probability of being cost-saving while gaining response or remission.

Conclusions:
This study is the first cost-effectiveness analysis of a guided digital mental health intervention in an LMIC. SbS provides greater health benefits at higher costs from the health care perspective, requiring decision-makers to balance costs and benefits. From the societal perspective, SbS is likely cost-saving due to increased productivity. Implementing SbS on a wide scale could benefit both health and the economy in Lebanon, offering a scalable solution to humanitarian emergencies in LMICs.