Article Text

Download PDFPDF

A guided and unguided internet- and mobile-based intervention for chronic pain: health economic evaluation alongside a randomised controlled trial
  1. Sarah Paganini1,2,
  2. Jiaxi Lin1,
  3. Fanny Kählke3,
  4. Claudia Buntrock3,
  5. Delia Leiding4,
  6. David D Ebert3,
  7. Harald Baumeister5
  1. 1 Department of Sports and Sport Science, Sport Psychology, University of Freiburg, Freiburg, Germany
  2. 2 Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
  3. 3 Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nuremberg, Erlangen, Germany
  4. 4 Department of Psychiatry, Psychotherapy and Psychosomatics, University of Aachen, Aachen, Germany
  5. 5 Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
  1. Correspondence to Sarah Paganini; sarah.paganini{at}


Objective This study aims at evaluating the cost-effectiveness and cost-utility of a guided and unguided internet-based intervention for chronic pain patients (ACTonPainguided and ACTonPainunguided) 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 (ACTonPainguided, ACTonPainunguided, 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 ACTonPainunguided (28% and 0.266; mean costs = €6,560) and the CG (16% and 0.244; mean costs = €6,908). ACTonPainguided vs CG revealed an ICER of €45 and an ICUR of €604.ACTonPainunguided dominated CG. At a willingness-to-pay of €0 the probability of being cost-effective was 50% for ACTonPainguided (vs CG, for both treatment response and QALY gained) and 67% for ACTonPainunguided (vs CG, for both treatment response and QALY gained). These probabilities rose to 95% when society’s willingness-to-pay is €91,000 (ACTonPainguided) and €127,000 (ACTonPainunguided) per QALY gained. ACTonPainguided vs ACTonPainunguided 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. ACTonPainunguided (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 ACTonPainguided.

Trial registration number DRKS00006183.

  • chronic pain
  • internet-and mobile-based intervention
  • health economic evaluation
  • cost-effectiveness
  • cost-utility
  • ehealth

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors JL and HB initiated the randomised controlled trial for this health economic evaluation. SP, FK, CB, DL and DDE contributed to the design of this health economic evaluation. SP, DL, FK and CB contributed to the data processing. SP conducted the data analysis. SP had full access to all the data in the study and had responsibility for the decision to submit for publication. SP wrote the draft of the manuscript. All authors contributed to the further writing and approved the final version of the manuscript.

  • Funding The article processing charge was funded by the German Research Foundation (DFG) and the Albert-Ludwigs University Freiburg in the funding programme Open Access Publishing.

  • Competing interests Two of the authors of the manuscript were involved in the development of ACTonPain (JL and HB). HB and DDE are consultants for several stakeholders (insurance companies, ministries, psychotherapy chambers, companies). DDE is part of the GET.ON Institut GmbH, which aims at implementing evidence-based internet-based and mobile based interventions into routine care. SP, CB, FK and DL declare that they have no competing interests.

  • Ethics approval The study has been registered in the German Clinical Trial Register (DRKS00006183) and was approved by the ethics committee of the University of Freiburg (reference: 387/14).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request.

  • Patient consent for publication Not required.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.