Health economic evaluation of internet-based cognitive behavioral therapy (ICBT) versus traditional CBT for generalized anxiety disorder (GAD) in India using Markov modeling, QALYs, ICER, and sensitivity analysis.
This project evaluates the cost-effectiveness of internet-delivered guided self-help cognitive behavioral therapy (ICBT) compared with traditional CBT for adults with generalized anxiety disorder (GAD) in India.
A health-state transition Markov model was developed to estimate costs and health outcomes over a 10-year time horizon from a societal perspective.
The analysis focuses on:
- 💻 Internet-based Cognitive Behavioral Therapy (ICBT)
- 🧠 Traditional Cognitive Behavioral Therapy (CBT)
- 📊 Markov health-state modeling
- 💵 Societal cost estimation
- ❤️ Quality-adjusted life years (QALYs)
- 📈 Incremental cost-effectiveness ratio (ICER)
- 🔍 Deterministic sensitivity analysis
Is ICBT cost-effective in comparison to traditional CBT in India?
- Evaluate the cost-effectiveness of ICBT compared with traditional CBT.
- Estimate total costs associated with each intervention.
- Estimate QALYs generated by each treatment strategy.
- Calculate the incremental cost-effectiveness ratio (ICER).
- Assess the robustness of the findings through sensitivity analysis.
A health-state transition Markov model was used to simulate the progression of GAD over time.
| Model Component | Description |
|---|---|
| ⏳ Time horizon | 10 years |
| 🔁 Cycle length | 3 months |
| 👥 Cohort | 1,000 adults aged 30–59 |
| 🌍 Setting | India |
| 💼 Perspective | Societal |
| ❤️ Outcome | QALYs |
| 💰 Economic evaluation | Cost-effectiveness analysis |
| 📉 Discount rate | 5% |
The model was adapted from a previously published Markov modeling approach.
Two treatment strategies were compared:
- ICBT — Internet-delivered guided self-help CBT
- Traditional CBT
The analysis incorporated relevant societal costs, including:
- 🏥 GAD-related healthcare utilization
- 💼 Societal/productivity costs
- 💻 Intervention costs
- 📚 Costs informed by published literature
- 👩⚕️ Expert-informed cost inputs where required
Treatment outcomes were measured using Quality-Adjusted Life Years (QALYs).
Both costs and benefits were discounted at 5% in the base-case analysis.
The incremental analysis compared ICBT with traditional CBT using:
Incremental Cost = Cost(ICBT) − Cost(Traditional CBT)
Incremental QALYs = QALYs(ICBT) − QALYs(Traditional CBT)
ICER = Incremental Cost / Incremental QALYs
Deterministic sensitivity analyses were conducted to examine how changes in key assumptions affected the results.
Scenarios included:
- 💰 Intervention cost ±20%
- 💼 Inclusion/exclusion of productivity costs
- 📉 Discount rates of 3%, 5%, and 7%
The sensitivity analyses showed that the overall conclusion remained robust.
| Outcome | Traditional CBT | ICBT |
|---|---|---|
| 💵 Total cost | $2,334,438.76 | $1,707,604.82 |
| ❤️ Total QALYs | 21,053.20 | 21,479.23 |
| 💰 Incremental cost | — | −$626,833.93 |
| ❤️ Incremental QALYs | — | +426.03 |
| 📈 ICER | — | −$1,471.33/QALY |
ICBT was less costly and more effective than traditional CBT in the base-case analysis and was therefore considered dominant.
Population & Treatment Strategies
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Markov Model
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Health-State Transitions
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Cost Estimation
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QALYs
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Incremental Analysis
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ICER
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Sensitivity Analysis
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Cost-Effectiveness Result
- 📊 Health economic modeling
- 🔄 Markov modeling
- 📈 Cost-effectiveness analysis
- 🧮 Incremental analysis
- ❤️ QALY estimation
- 💰 Cost analysis
- 🔍 Sensitivity analysis
- 📚 Evidence synthesis from published literature
- 🧠 Mental health / health economics research
- 🇮🇳 India-focused health economic evaluation
├── README.md
├── data/
├── model/
├── analysis/
├── results/
└── references/
The exact folder structure can be adapted to match the files used in the analysis.
The analysis relies partly on available published evidence and India-specific data limitations. Some model inputs were informed by expert opinion.
Further research could improve the analysis through:
- More robust India-specific efficacy estimates
- More detailed intervention cost estimates
- Improved estimates of societal/productivity costs
- Probabilistic sensitivity analysis
GAD creates a substantial burden for individuals and healthcare systems. Internet-based psychological interventions may provide a more accessible treatment option than conventional face-to-face therapy.
This project demonstrates how economic modeling and quantitative analysis can be used to evaluate whether alternative mental health interventions provide better value for money in a specific healthcare setting.
Health Economics • Mental Health • Cost-Effectiveness • Markov Models • Economic Evaluation • QALYs • ICER • Sensitivity Analysis • India