A systematic review of trial-based economic evaluations of internet- and mobile-based interventions for substance use disorders

Abstract

Background: Substance use disorders (SUDs) contribute significantly to global rates of morbidity and mortality. Internet-and mobile-based interventions (IMIs) have been suggested as an adjunct to face-to-face health services. However, the evidence for the cost-effectiveness of IMIs for SUDs is scant. Methods: A comprehensive literature search in PubMed, PsycINFO, the Cochrane Central Register of Controlled Trials, NHS Economic Evaluations Database, NHS Health Technology Assessment Database, Office of Health Economics Evaluations Database and EconLit was conducted. We included economic evaluations alongside randomized controlled trials of IMIs for SUDs compared with a control group. Results: Of 1687 abstracts identified, 11 studies met the inclusion criteria. Targeted conditions were alcohol use disorder (four studies) and tobacco smoking (five studies) whereas two studies included any SUD. Cost-effectiveness results demonstrated that IMIs had a firm probability of being more cost-effective than TAU (e.g. less costs per additional abstinent person). Compared with (online) psychoeducation, evidence towards an additional benefit of IMIs was less clear. Regarding cost-utility (e.g. costs per quality-adjusted life year gained), except for one study, results suggested that TAU and online psycho-education would probably be more preferable than IMIs. Quality of study reporting was at least adequate. Conclusions: The likelihood of IMIs being more cost-effective than TAU looks promising but more economic evaluations are needed in order to determine the economic merit of IMIs. With an increasing pressure on health care budgets, strategies to disseminate effective interventions at affordable costs are required. This review suggests that IMIs might carry that promise and have potential as a cost-effective strategy to scale-up existing evidence-based treatments for SUDs.

Reducing problematic alcohol use in employees: economic evaluation of guided and unguided web‐based interventions alongside a three‐arm randomized controlled trial

“…To our knowledge, this is the first trial‐based economic evaluation of an unguided and guided intervention to reduce problematic drinking in employees using a societal and an employer's perspectives. As such, results from our trial add to the growing evidence pointing to the cost‐effectiveness of IMIs for mental health disorders [14,55–57]. Blankers et al .…”

“…In addition, our findings agree with available health economic evidence from a recent systematic review showing the health economic benefits of IMIs for alcohol use disorder. Probabilities that IMIs were cost‐effective from a societal and a public health care perspective, respectively, ranged from 60 to 84% [14].…”

“…Probabilities that IMIs were cost-effective from a societal and a public health care perspective, respectively, ranged from 60 to 84% [14].…”

“…With respect to the economic merit of IMIs for problematic drinking, a modelling study revealed that the implementation of IMIs could substantially increase the cost‐effectiveness of health‐care systems for AUDs [13]. A recent systematic review on the cost‐effectiveness of IMIs for substance use disorders suggested that IMIs for AUDs provide good value for money, from both a public health‐care and a societal perspective [14]. The only study comparing an unguided and a guided IMI for problematic drinking in adults in a substance abuse treatment centre suggested that a guided IMI offered better value for money than an unguided IMI [15].…”

Effectiveness of guided and unguided online alcohol help: A real-life study

“…Effective internet-based interventions may reduce this gap due to their low-threshold accessibility, high scalability and reduced stigmatisation ( Riper et al, 2018 ). Moreover, internet- and mobile-based interventions are much more likely to be more cost effective than treatment as usual ( Buntrock et al, 2019 ; Buntrock et al, 2021 ).…”