EE8 Cost-Effectiveness and Cost-Utility of a Digital Wellness Intervention for Managing Depression and Anxiety: an Employer Perspective

To examine the cost-effectiveness and cost-utility for employers of a digital wellness intervention (DWI) for managing depression and anxiety relative to psychoeducation. A Markov model of 10,000 hypothetical individuals was created for a DWI (Happify Health) and psychoeducation to estimate costs (2019 USD), quality-adjusted life years (QALYs) and effectiveness. Four depression-related health states (none, mild, moderate, severe) were used, with a sub-distribution of anxiety levels (none, mild/moderate, severe) within each state. Effectiveness was defined as the proportion of people with severe depression who moved to milder depressive states and QALYs. Efficacy data from a RCT that compared a DWI to psychoeducation in people with moderate to severe depression (PHQ>9) was used. Direct medical costs, productivity loss costs and health utilities (short Form (SF)-6D) were estimated from Kantar’s 2019 National Health and Wellness Survey (NHWS) for each depression and concurrent anxiety level. Health utilities were converted into QALYs. Individuals were cycled through each intervention over 6 months, with cycle lengths of two months. Incremental cost-effectiveness ratios (ICER) and net monetary benefit (NMB) were estimated at a willingness-to-pay threshold of $150,000. Deterministic and two-way sensitivity analysis (SA) explored the impact of parameter uncertainty. Probabilistic SA estimated joint uncertainty. Data were analyzed in TreeAge Pro 2021 (TreeAge Software, Williamstown, MA). The DWI was cost-effective vs. psychoeducation with an ICER of -$24,437 per QALY gained. With respect to reducing severe depression, the DWI had incremental-effectiveness of 0.00480 and cost $108 relative to psychoeducation, resulting in an ICER of $22,479. The DWI was cost-effective in reducing severe symptoms when costs were $100-$360. The NMB was favorable in 50% of simulations under both measures. With respect to reduction of severe depression and QALYs, the DWI was cost-effective vs. psychoeducation and its introduction to employees could benefit employers.