A guided and unguided internet- and mobile-based intervention for chronic pain: health economic evaluation alongside a randomized controlled trial

Abstract: Objective:This study aims at evaluating the cost-effectiveness and cost-utility of a guided and unguided internet-based intervention for chronic pain patients (ACTonPain_guided and ACTonPain_unguided) compared with a waitlist control group (CG) as well as the comparative cost-effectiveness of the guided and the unguided version.

Design: This is a health economic evaluation alongside a three-arm randomised controlled trial from a societal perspective. Assessments were conducted at baseline, 9 weeks and 6 months after randomisation.

Setting: Participants were recruited through online and offline strategies and in collaboration with a health insurance company.

Participants: 302 adults (≥18 years, pain for at least 6 months) were randomly allocated to one of the three groups (ACTonPain_guided, ACTonPain_unguided, CG).

Interventions: ACTonPain consists of seven modules and is based on Acceptance and Commitment Therapy. ACTonPainguided and ACTonPainunguided only differ in provision of human support.

Primary and secondary outcome measures: Main outcomes of the cost-effectiveness and the cost-utility analyses were meaningful change in pain interference (treatment response) and quality-adjusted life years (QALYs), respectively. Economic evaluation estimates were the incremental cost-effectiveness and cost-utility ratio (ICER/ICUR).

Results: At 6-month follow-up, treatment response and QALYs were highest in ACTonPainguided (44% and 0.280; mean costs = €6,945), followed by ACTonPain_unguided (28% and 0.266; mean costs = €6,560) and the CG (16% and 0.244; mean costs = €6,908). ACTonPain_guided vs CG revealed an ICER of €45 and an ICUR of €604.ACTonPain_unguided dominated CG. At a willingness-to-pay of €0 the probability of being cost-effective was 50% for ACTonPain_guided (vs CG, for both treatment response and QALY gained) and 67% for ACTonPain_unguided (vs CG, for both treatment response and QALY gained). These probabilities rose to 95% when society’s willingness-to-pay is €91,000 (ACTonPain_guided) and €127,000 (ACTonPain_unguided) per QALY gained. ACTonPain_guided vs ACTonPain_unguided revealed an ICER of €2,374 and an ICUR of €45,993.

Conclusions: Depending on society’s willingness-to-pay, ACTonPain is a potentially cost-effective adjunct to established pain treatment. ACTonPain_unguided (vs CG) revealed lower costs at better health outcomes. However, uncertainty has to be considered. Direct comparison of the two interventions does not indicate a preference for ACTonPain_guided

Object Details

• Location: Deutsche Nationalbibliothek Frankfurt am Main
• Extent: Online-Ressource
• Language: Englisch
• Notes: BMJ open. - 9 (2019) , e023390, ISSN: 2044-6055

Classification and Topics

• Keyword: Chronischer Schmerz

Contributors, Places and Time

• Event: Veröffentlichung
• (where): Freiburg
• (who): Universität
• (when): 2019
• Creator: Paganini, Sarah ; Lin, Jiaxi ; Kählke, Fanny ; Buntrock, Claudia ; Leiding, Delia ; Ebert, David Daniel ; Baumeister, Harald

Further information

• DOI: 10.1136/bmjopen-2018-023390
• URN: urn:nbn:de:bsz:25-freidok-1500857
• Rights: Der Zugriff auf das Objekt ist unbeschränkt möglich.
• Last update: 15.08.2025, 7:33 AM CEST