4. Discussion
DISORDER, MINOR, DISORDERS
Almost all participants of the clinical evaluation could be included in the health economic evaluation since only 11 persons lacked data on the health economic questionnaire. Overall, it can be assumed that there were only minor restrictions regarding the transferability of the results for the entire OMPRIS study population. For the four-week intervention period, an ICER of EUR 861.30/PRC could be calculated from the SHI perspective and EUR 1109.57/PRC from the societal perspective. The result of ICER is robust to univariate changes in cost components up to the extent of a 10% change. Results are sensitive to changes in intervention costs.Cognitive behavioral therapy as a short-term therapy could be used as a comparative intervention from the perspective of statutory health insurance for patients aged 21 and older in Germany. At EUR 2211 for individual therapy [For the included participants of the health economic evaluation, the AICA-S score showed a statistically significant effect in favor of the IG. In both the IG and the WCG, the mean AICA-S score measured at baseline was within the risky range and could be reduced to the non-risky range after the intervention in the IG but not in the WCG. Detailed results on the efficacy of the OMPRIS intervention have already been published by the OMPRIS Research Group [The health-related quality of life, measured by the EQ-5D-5L index, indicated an improvement in T2 compared to the baseline survey in both groups. The increase in quality of life was higher in the IG; however, the differences were not statistically significant. Therefore, it was not possible to perform a CUA. For the EQ-5D-5L instrument, low sensitivity and ceiling effects are discussed [The rather young cohort tended toward a low utilization of health services. Therefore, the reported intervention costs were the main cost driver. Since general training, hardware and software costs were not included in the calculation, the intervention costs tended to be underestimated. If the OMPRIS intervention was to be integrated into the care of statutorily insured patients in Germany, a more accurate analysis of the costs from the SHI perspective could be performed by determining the remuneration of the intervention costs. Regarding the high impact of intervention costs, it seems to be important to take the clinical results of OMPRIS into account. These indicate different mental comorbidities coming along in patients with Internet Use Disorders, which—if untreated—could lead to high expenses.Psychotherapy with a behavioral focus is currently considered the gold standard treatment for IUD in Germany and worldwide. Although there are therapeutic manuals for IUD treatment, there are hardly any psychotherapists with experience in the treatment of IUD. The OMPRIS intervention, which is specifically tailored to the IUD and has achieved a statistically significant positive effect on IUD symptom reduction, could close the gap in the treatment of this relatively newly described disorder in Germany. The OMPRIS intervention has not yet been implemented in standard care and is not reimbursed by the SHI. The present calculation of intervention costs and cost-effectiveness (ICER), taking into account the AICA-S, could serve as a first basis for the German Joint Federal Committee’s (Gemeinsamer Bundesausschuss) decision on the potential reimbursement of this intervention by the SHI. The WCG design of the study can be discussed as a limiting factor. The participants in the WCG started the intervention once the intervention in the IG was completed. This resulted in a relatively short period of time to conduct a comparative analysis of the development of health-related costs. Potentially, there may have been a change in resource use as a result of the intervention that can only be observed in the weeks following the intervention. A much longer observation period to observe the development of costs would be preferable. Furthermore, the impact of assignment to a WCG on the outcomes is discussed. It could result in both an improvement due to the conducted initial interviews and an anticipation of the intervention and deterioration due to disappointment because of the assignment to the WCG [A limiting factor for the results of this study was the questionnaire-based collection of resource use data. Such retrospective data collection has the potential to be subject to recall bias, which means that health service utilization could only be partially recorded. Due to the short survey periods of a few weeks, a possible bias due to the recall bias should be marginal. In addition, as described above, the relatively short follow-up period can be considered a limitation.