Cost-benefit of IAPT Norway and effects on work-related outcomes and health care utilization: results from a randomized controlled trial using registry-based data

Background Data from an RCT of IAPT Norway ("Prompt Mental Health Care" [PMHC]) were linked to several administrative registers up to five years following the intervention. The aims were to (1) examine the effects of PMHC compared to treatment-as-usual (TAU) on work-related outcomes and health care use, (2) estimate the cost-benefit of PMHC, and (3) examine whether clinical outcomes at six-month follow-up explained the effects of PMHC on work-/cost-benefit-related outcomes.Methods RCTs with parallel assignment were conducted at two PMHC sites (N = 738) during 2016/2017. Eligible participants were considered for admission due to anxiety and/or depression. We used Bayesian estimation with 90% credibility intervals (CI) and posterior probabilities (PP) of effects in favor of PMHC. Primary outcome years were 2018-2022. The cost-benefit analysis estimated the overall economic gain expressed in terms of a benefit-cost ratio and the differences in overall public sector spending.Results The PMHC group was more likely than the TAU group to be in regular work without receiving welfare benefits in 2019-2022 (1.27 <= OR <= 1.43). Some evidence was found that the PMHC group spent less on health care. The benefit-cost ratio in terms of economic gain relative to intervention costs was estimated at 5.26 (90%CI $ - $ 1.28, 11.8). The PP of PMHC being cost-beneficial for the economy as a whole was 85.9%. The estimated difference in public sector spending was small. PMHC effects on work participation and cost-benefit were largely explained by PMHC effects on mental health.Conclusions The results support the societal economic benefit of investing in IAPT-like services.