Journal Article

A Universal Digital Stress Management Intervention for Employees: Randomized Controlled Trial with Health-Economic Evaluation

Berking, Matthias, Lehr, Dirk, Funk, Burkhardt, Ebert, David Daniel, Smit, Filip, Riper, Heleen, Zarski, Anna-Carlotta, Freund, Johanna, Buntrock, Claudia

2024

Overview

Stress is highly prevalent and known to be a risk factor for a wide range of physical and mental disorders. The effectiveness of digital stress management interventions has been confirmed; however, research on its economic merits is still limited. This study aims to assess the cost-effectiveness, cost-utility, and cost-benefit of a universal digital stress management intervention for employees compared with a waitlist control condition within a time horizon of 6 months. Recruitment was directed at the German working population. A sample of 396 employees was randomly assigned to the intervention group (n=198) or the waitlist control condition (WLC) group (n=198). The digital stress management intervention included 7 sessions plus 1 booster session, which was offered without therapeutic guidance. Health service use, patient and family expenditures, and productivity losses were self-assessed and used for costing from a societal and an employer's perspective. Costs were related to symptom-free status (PSS-10 [Perceived Stress Scale] score 2 SDs below the study population baseline mean) and quality-adjusted life years (QALYs) gained. The sampling error was handled using nonparametric bootstrapping. From a societal perspective, the digital intervention was likely to be dominant compared with WLC, with a 56% probability of being cost-effective at a willingness-to-pay (WTP) of €0 per symptom-free person gained. At the same WTP threshold, the digital intervention had a probability of 55% being cost-effective per QALY gained relative to the WLC. This probability increased to 80% at a societal WTP of €20,000 per QALY gained. Taking the employer's perspective, the digital intervention showed a probability of a positive return on investment of 78%. Digital preventive stress management for employees appears to be cost-effective societally and provides a favorable return on investment for employers. German Clinical Trials Register DRKS00005699; https://drks.de/search/en/trial/DRKS00005699.

• Publisher: Journal of Medical Internet Research,Gunther Eysenbach MD MPH, Associate Professor,JMIR Publications
• Subject: Adult / Bootstrap method / Bootstrapping / Clinical research / Clinical trials / Coping / Cost analysis / Cost benefit analysis / Cost-Benefit Analysis - statistics & numerical data / Costing / Costs / Disorders / E-health / Economic aspects / Economic research / Employees / Employers / Female / Germany / Health aspects / Health care expenditures / Health insurance / Health services / Health services utilization / Humans / Insurance companies / Internet access / Intervention / Job stress / Male / Management / Mental disorders / Mental health / Mental health services / Mental illness / Methods / Middle Aged / Occupational health / Occupational health and safety / Original Paper / Prevention / Probability / Productivity / Psychological aspects / Quality adjusted life years / Quality of life / Recruitment / Registration / Return on investment / Risk factors / Sampling / Self evaluation / Social aspects / Stress / Stress management / Stress, Psychological - economics / Stress, Psychological - therapy / Symptoms / Technology application / Wellness programs / Willingness to pay