Cost-effectiveness and cost-utility of a therapist-guided online intervention provided soon after trauma: Results from a randomized controlled trial

This study evaluated the cost-effectiveness and cost-utility of a therapist-guided, internet-delivered early intervention for trauma. Exposure to traumatic events is common and can lead to substantial psychological distress, functional impairment, and societal costs. Early psychological interventions have the potential to mitigate these effects. We developed Condensed Internet-delivered Prolonged Exposure (CIPE), a digital intervention delivered within two months of trauma exposure. In a randomized controlled trial (<i>N</i> = 102), CIPE was more effective than a waiting-list control in reducing post-traumatic stress symptoms at post-intervention (3 weeks) and at a prespecified 7-week follow-up while the waiting-list control remained intact (prior to crossover). In this study, we evaluated CIPE from a societal cost perspective, aggregating direct medical costs (healthcare contacts, medication) and indirect costs (sick leave, reduced productivity, domestic loss) with equal weight in total cost calculations using a self-report questionnaire. Cost-effectiveness was assessed using responder status (≥10-point symptom reduction) and subthreshold symptom status on the PTSD Checklist for DSM-5. Cost-utility was assessed using quality-adjusted life years (QALYs) from the EQ-5D. Incremental cost-effectiveness ratios (ICERs) were estimated using bootstrapped regression analyses and visualized in cost-effectiveness planes and acceptability curves. CIPE showed a 95 % probability of being cost-effective at a willingness-to-pay threshold of €939-1181 per additional responder or subthreshold case. The corresponding cost per QALY gained was €2929-3636. Effects were sustained at 12-month follow-up. These findings suggest that therapist-guided digital exposure therapy delivered soon after trauma can reduce symptoms at a relatively low cost to society. Future research should examine CIPE's long-term economic impact and potential for broader implementation.