Widespread psychological problems (CMDs), together with melancholy, anxiousness, and stress-related situations, are main contributors to world incapacity and illness absence. In Sweden, they account for a major share of long-term sick go away, affecting each particular person wellbeing and nationwide productiveness (Helgesson et al., 2025; Falkenberg et al., 2025).
As digital well being companies develop, curiosity is rising of their potential to ship person-centred care (PCC) at scale. PCC promotes a collaborative method that centres on sufferers’ values, objectives, and capabilities, relatively than simply symptom aid (Ekman et al., 2011; Forsgren et al., 2025).
The PROMISE trial, carried out in Sweden, examined a digitally delivered PCC intervention for people on sick go away as a result of CMDs (Cederberg et al., 2022). Early findings have proven reductions in fatigue (Alsen, 2025).
Kebede et al. (2025) evaluated the cost-effectiveness of the PROMISE intervention, in search of to reply whether or not the intervention is not only clinically useful, but additionally a smart use of restricted sources.
Can digital person-centred care provide an economical answer for psychological health-related sick go away in Sweden?
Strategies
The PROMISE trial was a non-blinded randomised managed trial carried out throughout 9 public major healthcare centres in Sweden from February 2018 to June 2020. Members have been adults on sick go away as a result of CMDs, with diagnoses of melancholy, anxiousness, or stress-related problems. A complete of 206 people (>80% ladies) have been enrolled and randomised into considered one of two teams: 100 contributors within the eHealth intervention + care as typical group, and 106 contributors within the care as typical group.
The intervention itself comprised a structured PCC delivered by healthcare professionals by way of telephone and a safe web-based platform and included:
- an preliminary person-centred dialog
- the event of a personalised well being plan, and
- ongoing digital help.
The healthcare professionals who delivered the intervention included nurses, a physiotherapist, and an occupational therapist who obtained a half-day coaching in CMDs from psychologists and physicians, and extra coaching in PCC philosophy from researchers in related fields, supported by reflective boards with PCC specialists all through the intervention. The digital platform was developed by the College of Gothenburg and allowed sufferers to trace progress and keep communication with suppliers. Regular care included GP consultations, treatment, psychological remedy, and rehabilitation companies.
The first well being consequence for the cost-effectiveness evaluation was quality-adjusted life years (QALYs), calculated utilizing the EQ-5D-3L instrument which assesses 5 dimensions of health-related high quality of life: mobility, self-care, day by day actions, ache/discomfort, and melancholy/anxiousness. Outcomes have been measured at baseline, 3, 6, and 12 months. Prices included healthcare utilisation, drug prices, and productiveness losses (sick go away days). Information have been sourced from Swedish nationwide registries. The financial analysis employed incremental cost-effectiveness ratios (ICERs).
Might a digital, professional-delivered, person-centred care intervention for adults on sick go away as a result of CMDs be cheaper than typical care over 12 months?
Outcomes
When it comes to cost-effectiveness, the examine discovered that:
- Members within the intervention group had barely greater QALYs (0.813) than these within the management group (0.807), reflecting a really small beneficial well being achieve.
- In the meantime, complete societal prices have been decrease within the intervention group, at 183,352 Swedish Krona (SEK) per affected person (£14,314.09), in comparison with SEK 203,648 (£15,898.58) within the management group, a imply saving of SEK 20,296 (£1,584.49) per particular person.
- The ensuing ICER was SEK 23.8 million (£1,858,039.82) per QALY gained. Though this determine might seem excessive, probabilistic sensitivity evaluation indicated a 76.3% chance that the intervention was cost-effective inside Sweden’s willingness-to-pay threshold.
- Price financial savings have been primarily attributed to diminished drug prices and decrease productiveness losses. Particularly, sufferers within the intervention group used fewer non-antidepressant psychotropic drugs and had fewer sick go away days.
The intervention confirmed modest potential for cost-effectiveness, pushed primarily by diminished treatment use and fewer sick go away days.
Conclusions
The intervention seems possible, scalable, and even cost-saving, particularly when factoring in diminished treatment use and fewer sick go away days. However the well being achieve was minimal, and the excessive uncertainty round cost-effectiveness means it’s tough to advocate wide-scale adoption based mostly on this examine alone.
Total, the result of this examine demonstrates a viable proof-of-concept: it reveals that efficient and environment friendly person-centred psychological healthcare might be supplied digitally, however the true problem lies forward.
Strengths and limitations
The examine used a realistic design, carried out in real-world major care settings in Sweden, enhancing the relevance of the findings to routine scientific follow.
The inclusion of contributors with a spread of sick go away durations and CMD signs displays the scientific range present in real-world healthcare. An necessary energy lies in its price evaluation, which included each direct healthcare prices (e.g., consultations, drugs) and broader societal prices similar to misplaced productiveness, offering helpful insights for policymakers weighing system-wide advantages. The feasibility of the intervention additionally lies in it being delivered by non-specialist healthcare professionals, together with registered nurses. This helps its scalability in major care, notably in settings the place entry to psychological well being specialists is proscribed. The researchers additionally examined the robustness of their findings below totally different analytical assumptions, strengthening the boldness in the principle findings.
Nonetheless, it is very important think about that the cost-effectiveness outcomes have been extremely variable, as mirrored in a really excessive incremental cost-effectiveness ratio of SEK 23.8 million (£1,858,039.82) per QALY gained. Though the intervention was cost-saving general, the small well being achieve means the ICER alone doesn’t imply the intervention must be adopted at a nationwide stage.
Moreover, the noticed QALY beneficial properties have been minimal, elevating questions on whether or not the intervention meaningfully improved health-related high quality of life, even when it did assist cut back prices. Then again, whereas QALYs stay the gold commonplace for cost-effectiveness evaluations (Le et al., 2021), they might not totally seize the affect of psychological well being interventions, particularly these targeted on work participation and restoration (Franklin & Alava, 2023).
The follow-up interval was restricted to 12 months, which is probably not lengthy sufficient to completely seize well being and financial outcomes for individuals with frequent psychological problems, particularly concerning return-to-work trajectories or sustained enhancements in wellbeing. As well as, the intervention relied on a digital platform developed by a Swedish college, however the price of constructing, implementing, and sustaining this platform was not included within the financial evaluation. If adopted at scale, new or tailored digital instruments could also be required, doubtlessly incurring substantial prices that would alter the general cost-effectiveness.
The examine provides real-world insights into price and scalability; however modest well being beneficial properties, unsure cost-effectiveness, and lack of digital platform price information increase questions on wider implementation.
Implications for follow
The authors counsel key implications for follow and analysis based mostly on their findings:
- Digitally delivered person-centred care might provide an economical method to supporting people on sick go away as a result of frequent psychological problems (CMDs), particularly when considered from a societal perspective that features productiveness loss.
- In addition they spotlight the potential for this mannequin to reinforce continuity and coordination in care, particularly when healthcare professionals are capable of type collaborative, goal-oriented relationships with sufferers over time.
Past the authors’ suggestions, there are necessary implications that researchers, policymakers and healthcare suppliers ought to think about:
- Future research ought to think about complementary measures, similar to functionality or work functioning outcomes, which can higher replicate the affect of CMDs and restoration in working-age adults.
- Though the intervention demonstrated price financial savings and feasibility below trial situations, real-world implementation might face sensible challenges. These embrace workers capability, variable engagement throughout suppliers, and digital entry and literacy limitations for some sufferers. Future analysis ought to discover these components, together with coaching and supervision fashions, to help sustainable supply at scale.
- Whereas the intervention’s supply by non-specialist healthcare professionals makes it scalable and cost-efficient, the restricted length of coaching might have diminished the intervention’s scientific effectiveness, notably for contributors with extra advanced wants. Future analysis ought to study whether or not extra intensive or tailor-made coaching might improve outcomes with out considerably rising prices.
- This examine additionally factors to a possible function for university-developed digital platforms in healthcare innovation. Nonetheless, long-term adoption might require integration with current IT infrastructure, information governance, and person expertise design, which aren’t captured in cost-effectiveness analyses.
- The NHS is already investing in e-mental well being interventions, together with Digitally Enabled Therapies (DETs), NHS-approved apps (e.g. SilverCloud, Sleepio), and AI-driven triage instruments. Nonetheless, the structured, person-centred mannequin used within the Swedish trial just isn’t but extensively carried out. Integrating such an method into NHS Speaking Therapies or return-to-work companies would require funding in workforce coaching, digital infrastructure, and analysis of usability and accessibility throughout various populations. Nonetheless, the groundwork exists to adapt and pilot comparable fashions throughout the UK well being system.
Digitally delivered person-centred care may very well be scalable, however would require funding in coaching, digital infrastructure, and consequence measures that higher seize psychological well being restoration.
Assertion of pursuits
I’ve no competing pursuits to declare.
Hyperlinks
Major paper
Kebede TT, Cederberg M, Alsén S, Fors A, Gyllensten H. A Particular person-Centered eHealth Intervention for Sufferers With Widespread Psychological Issues: Price-Effectiveness Evaluation Inside a Randomized Managed Trial. Worth Well being. 2025 Jun;28(6):875-883. doi: 10.1016/j.jval.2025.03.011. Epub 2025 Apr 10. PMID: 40220864.
Different references
Alsén, S., Cederberg, M., & Fors, A. (2025). An individual-centred care intervention supplied by way of eHealth to cut back fatigue in sufferers with frequent psychological problems–secondary consequence evaluation from a randomized managed trial. Scandinavian Journal of Major Well being Care, 1-10.
Cederberg, M., Alsén, S., Ali, L., Ekman, I., Glise, Ok., Jonsdottir, I. H., … & Fors, A. (2022). Results of a person-centered eHealth intervention for sufferers on sick go away as a result of frequent psychological problems (PROMISE examine): open randomized managed trial. JMIR Psychological Well being, 9(3), e30966.
Ekman, I., Swedberg, Ok., Taft, C., Lindseth, A., Norberg, A., Brink, E., Carlsson, J., Dahlin-Ivanoff, S., Johansson, I.-L., Kjellgren, Ok., Lidén, E., Öhlén, J., Olsson, L.-E., Rosén, H., Rydmark, M., & Stibrant Sunnerhagen, Ok. (2011). Particular person-centered care—Prepared for prime time. European Journal of Cardiovascular Nursing, 10(4), 248–251. https://doi.org/10.1016/j.ejcnurse.2011.06.008
Falkenberg, H., Nygren, A., & Jensen, I. (2025). Diagnoses of frequent psychological problems and long-term work incapacity: A 20-year longitudinal examine utilizing Swedish nationwide information. Journal of Occupational Rehabilitation, 35(1), 88–99. https://doi.org/10.1007/s10728-024-00491-1
Forsgren, E., Feldthusen, C., Wallström, S., Thunström, L., Kullman, L., Sawatzky, R., & Öhlén, J. (2025). Particular person-centred care as an evolving area of analysis: a scoping evaluation. Frontiers in Well being Providers, 5, 1534178.
Franklin, M., & Hernández Alava, M. (2023). Enabling QALY estimation in psychological well being trials and care settings: mapping from the PHQ-9 and GAD-7 to the ReQoL-UI or EQ-5D-5L utilizing combination fashions. High quality of Life Analysis, 32(10), 2763-2778.
Helgesson, M., Gustafsson, Ok., & Leineweber, C. (2025). Analysis-specific sick go away and the function of a nationwide return-to-work program: A population-based matched cohort examine. Journal of Occupational Rehabilitation, 35(2), 263–274. https://doi.org/10.1007/s10926-025-10269-4
Le, L. Ok. D., Esturas, A. C., Mihalopoulos, C., Chiotelis, O., Bucholc, J., Chatterton, M. L., & Engel, L. (2021). Price-effectiveness proof of psychological well being prevention and promotion interventions: A scientific evaluation of financial evaluations. PLoS drugs, 18(5), e1003606.
