Skip to main content Accessibility help

Economic evaluations of Internet interventions for mental health: a systematic review

  • T. Donker (a1) (a2) (a3), M. Blankers (a4), E. Hedman (a5) (a6), B. Ljótsson (a6), K. Petrie (a3) and H. Christensen (a3)...



Internet interventions are assumed to be cost-effective. However, it is unclear how strong this evidence is, and what the quality of this evidence is.


A comprehensive literature search (1990–2014) in Medline, EMBASE, the Cochrane Central Register of Controlled Trials, NHS Economic Evaluations Database, NHS Health Technology Assessment Database, Office of Health Economics Evaluations Database, Compendex and Inspec was conducted. We included economic evaluations alongside randomized controlled trials of Internet interventions for a range of mental health symptoms compared to a control group, consisting of a psychological or pharmaceutical intervention, treatment-as-usual (TAU), wait-list or an attention control group.


Of the 6587 abstracts identified, 16 papers met the inclusion criteria. Nine studies featured a societal perspective. Results demonstrated that guided Internet interventions for depression, anxiety, smoking cessation and alcohol consumption had favourable probabilities of being more cost-effective when compared to wait-list, TAU, group cognitive behaviour therapy (CBGT), attention control, telephone counselling or unguided Internet CBT. Unguided Internet interventions for suicide prevention, depression and smoking cessation demonstrated cost-effectiveness compared to TAU or attention control. In general, results from cost-utility analyses using more generic health outcomes (quality of life) were less favourable for unguided Internet interventions. Most studies adhered reasonably to economic guidelines.


Results of guided Internet interventions being cost-effective are promising with most studies adhering to publication standards, but more economic evaluations are needed in order to determine cost-effectiveness of Internet interventions compared to the most cost-effective treatment currently available.


Corresponding author

* Address for correspondence: T. Donker, PhD, Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email:


Hide All
Arnberg, FK, Linton, SJ, Hultcrantz, M, Heintz, E, Jonsson, U (2014). Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness. PLoS ONE 9, e98118.
Beck, AT, Steer, RA, Ball, R, Ranieri, WF (1996). Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. Journal of Personality Assessment 67, 588597.
Bencic, W, Bucsics, A, Dressler, H, Gerold, W, Hartinger, B, Hauser, A, Huber, JO, Krammer, H, Kratzer, H, Muller, M, Penk, A, Placheta, P, Probst, J, Spanninger, G, Wieninger, P, Wild, C, Windischbauer, A (2006). Guidelines on Health Economic Evaluation. Vienna: Institut fur Pharmaokonomische Forschung.
Bergström, J, Andersson, G, Ljótsson, B, Rück, C, Andréewitch, S, Karlsson, A, Carlbring, P, Andersson, E, Lindefors, N (2010). Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BMC Psychiatry 10, 54.
Blankers, M, Koeter, MWJ, Schippers, GM (2011). Internet therapy versus internet self-help versus no treatment for problematic alcohol use: a randomized controlled trial. Journal of Consulting and Clinical Psychology 79, 330341.
Blankers, M, Nabitz, U, Smit, F, Koeter, MW, Schippers, GM (2012). Economic evaluation of internet-based interventions for harmful alcohol use alongside a pragmatic randomized controlled trial. Journal of Medical Internet Research 14, e134.
Bower, P, Richards, D, Lovell, K (2001). The clinical and cost-effectiveness of self-help treatments for anxiety and depressive disorders in primary care: a systematic review. British Journal of General Practice 51, 838845.
Chen, YF, Madan, J, Welton, N, Yahaya, I, Aveyard, P, Bauld, L, Wang, D, Fry-Smith, , Munafò, MR (2012). Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis. Health Technology Assessment 16, 1205.
Civljak, M, Stead, LF, Hartmann-Boyce, J, Sheikh, A, Car, J (2014). Internet-based interventions for smoking cessation. The Cochrane Database of Systematic Reviews 10, CD007078.
Drummond, MF, Jefferson, TO (1996). Guidelines for authors and peer reviewers of economic submissions to BMJ. British Medical Journal 313, 275283.
Drummond, MF, Sculpher, MJ, Torrance, GW, O'Brien, BJ, Stoddart, GL (2005). Methods for the Economic Evaluation of Health Care Programmes, 3rd edn. Oxford University Press: New York, USA.
EuroQol-Group (1990). Euroqol – a new facility for the measurement of health-related quality of life. Health Policy 16, 199208.
Exchange-Rates. Wereld valuta wisselkoersen en valuta wisselkoers historie. Historical Rates.; Accessed 17 October 2014.
Gerhards, SAH, de Graaf, LE, Jacobs, LE, Severens, JL, Huibers, MJH, Arntz, A, Riper, H, Widdershoven, G, Metsemakers, JFM, Evers, SMAA (2010). Economic evaluation of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial. British Journal of Psychiatry 196, 310318.
Gilbody, S, Bower, P, Whitty, P (2006). Costs and consequences of enhanced primary care for depression: systematic review of randomised economic evaluations. British Journal of Psychiatry 189, 297308.
Graham, AL, Chang, Y, Fang, Y, Cobb, NK, Tinkelman, DS, Niaura, RS, Abrams, DB, Mandelblatt, JS (2012). Cost-effectiveness of internet and telephone treatment for smoking cessation: an economic evaluation of The iQUITT Study. Tobacco Control 22, e11.
Hedman, E, Andersson, E, Ljótsson, B, Andersson, G, Rück, C, Lindefors, N (2011). Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: results from a randomized controlled trial. Behaviour Research and Therapy 49, 729736.
Hedman, E, Andersson, E, Lindefors, N, Andersson, G, Rück, C, Ljótsson, B (2012 a). Cost-effectiveness and long-term effectiveness of Internet-based cognitive behaviour therapy for severe health anxiety. Psychological Medicine 43, 112.
Hedman, E, El Alaoui, S, Lindefors, N, Andersson, E, Rück, C, Ghaderi, A, Kaldo, V, Lekander, M, Andersson, G, Ljótsson, B (2014). Clinical effectiveness and cost-effectiveness of Internet- vs. group-based cognitive behavior therapy for social anxiety disorder: 4-year follow-up of a randomized trial. Behaviour Research and Therapy 59, 2029.
Hedman, E, Ljótsson, B, Lindefors, N (2012 b). Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Review of Pharmacoeconomics & Outcomes Research 12, 745764.
Hollinghurst, S, Peters, TJ, Kaur, S, Wiles, N, Lewis, G, Kessler, D (2010). Cost-effectiveness of therapist-delivered online cognitive-behavioural therapy for depression: randomised controlled trial. British Journal of Psychiatry, 197, 297304.
Husereau, D, Drummond, M, Petrou, S, Carswell, C, Moher, D, Greenberg, D, Augustovski, F, Briggs, AH, Mauskopf, J, Loder, E (2013). Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Cost Effectiveness and Resource Allocation: C/E 11, 1, 6.
Javitz, HS, Zbikowski, SM, Deprey, M, Mcafee, TA, Mcclure, JB, Richards, J, Catz, SL, Jack, LM, Swan, GE (2011). Cost-effectiveness of varenicline and three different behavioral treatments for smoking cessation. Translational Behavioral Medicine 1, 182190.
Karanikolos, M, Mladovsky, P, Cylus, J, Thomson, S, Basu, S, Stuckler, D, Mackenback, JP, McKee, M (2013). Financial crisis, austerity, and health in Europe. Lancet 381, 13231331.
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR & Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.
Kraemer, KL (2008). The cost-effectiveness and cost-benefit of screening and brief intervention for unhealthy alcohol use in medical settings. Substance Abuse 28, 677.
Mihalopoulos, C, Chatterton, ML (2014). Economic evaluations of interventions designed to prevent mental disorders: a systematic review. Early Intervention in Psychiatry 9, 8592.
Muennig, P (2007). Cost-Effectiveness Analysis in Health: A Practical Approach, 2nd edn. Jossey-Bass: San Francisco.
Nordgren, LB, Hedman, E, Etienne, J, Bodin, J, Kadowaki, A, Eriksson, S, Lindkvist, E, Andersson, G, Carlbring, P (2014). Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: a randomized controlled trial. Behaviour Research and Therapy 59, 111.
Phillips, R, Schneider, J, Molosankwe, I, Leese, M, Foroushani, PS, Grime, P, McCrone, P, Morriss, R, Thornicroft, G (2014). Randomized controlled trial of computerized cognitive behavioural therapy for depressive symptoms: effectiveness and costs of a workplace intervention. Psychological Medicine 44, 741752.
Richards, D, Richardson, T (2012). Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clinical Psychology Review 32, 329342.
Riper, H, Blankers, M, Hadiwijaya, H, Cunningham, J, Clarke, S, Wiers, R, Eber, D, Cuijpers, P (2014). Effectiveness of guided and unguided low-intensity internet interventions for adult alcohol misuse: a meta-analysis. PLoS ONE 9, e99912.
Ritterband, LM, Thorndike, FP, Gonder-Frederick, LA, Magee, JC, Bailey, ET, Saylor, DK, Morin, CM (2009). Efficacy of an Internet-based behavioral intervention for adults with insomnia. Archives of General Psychiatry 66, 692698.
Rodgers, M, Asaria, M, Walker, S, McMillan, D, Lucock, M, Harden, M, Palmer, S, Eastwood, A (2012). The clinical effectiveness and cost-effectiveness of low intensity psychological interventions for the secondary prevention of relapse after depression: a systematic review. Health Technology Assessment 16, 1130.
Ronckers, ET, Groot, W, Ament, AJHA (2014). Systematic review of economic evaluations of smoking cessation: standardizing the cost-effectiveness. Medical Decision Making 25, 437448.
Saha, S, Hoerger, TJ, Pignone, MP, Teutsch, SM, Helfand, M, Mandelblatt, JS (2001). The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services. American Journal of Preventive Medicine 20, 3643.
Saunders, JB, Aasland, OG, Babor, TF, de la Fuente, JR, Grant, M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption – II. Addiction, 88, 791804.
Smit, ES, Evers, SMAA, De Vries, H, Hoving, C (2013). Cost-effectiveness and cost-utility of internet-based computer tailoring for smoking cessation. Journal of Medical Internet Research 15, e57.
Tate, DF, Finkelstein, EA, Khavjou, O, Gustafson, A (2009). Cost effectiveness of internet interventions: review and recommendations. Annals of Behavioral Medicine 38, 4045.
Titov, N, Andrews, G, Johnston, L, Schwencke, G, Choi, I (2009). Shyness programme: longer term benefits, cost-effectiveness, and acceptability. Australian and New Zealand Journal of Psychiatry 43, 3644.
Van Spijker, BAJ, van Straten, A, Kerkhof, AJFM (2014). Effectiveness of online self-help for suicidal thoughts: results of a randomised controlled trial. PLoS ONE 9, e90118.
Van Spijker, BAJ, Majo, MC, Smit, F, van Straten, A, Kerkhof, AJFM (2012). Reducing suicidal ideation: cost-effectiveness analysis of a randomized controlled trial of unguided web-based self-help. Journal of Medical Internet Research 14, e141.
Wade, AG, Häring, J (2010). A review of the costs associated with depression and treatment noncompliance: the potential benefits of online support. International Clinical Psychopharmacology 25, 288296.
Wallace, P, Murray, E, McCambridge, J, Khadjesari, Z, White, IR, Thompson, SG, Kalitzaki, E, Godfrey, C, Linke, S (2011). On-line randomized controlled trial of an internet based psychologically enhanced intervention for people with hazardous alcohol consumption. PLoS ONE 6, e14740.
Warmerdam, L, Smit, F, van Straten, A, Twisk, J, Riper, H, Cuijpers, P (2010). Cost-Utility and Cost-Effectiveness of Internet-based treatment for adults with depressive symptoms: randomized Trial. Journal of Medical Internet Research 12, e53.
Warmerdam, L, van Straten, A, Twisk, J, Riper, H, Cuijpers, P (2008). Internet-based treatment for adults with depressive symptoms: randomized controlled trial. Journal of Medical Internet Research 10, e44.
Wittchen, HU, Fuetsch, M, Sonntag, H, Müller, N & Liebowitz, M (2000). Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study. European Psychiatry 15, 4658.
World Bank Data (2014). Inflation, GDP deflator (annual%).; Accessed 17 October 2014.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Donker supplementary material

 Word (12 KB)
12 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed