Widespread psychological issues (CMDs), together with despair, nervousness, and stress-related circumstances, are main contributors to international incapacity and illness absence. In Sweden, they account for a major share of long-term sick depart, affecting each particular person wellbeing and nationwide productiveness (Helgesson et al., 2025; Falkenberg et al., 2025).
As digital well being providers 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, targets, and capabilities, somewhat than simply symptom reduction (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 depart 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, searching for to reply whether or not the intervention is not only clinically useful, but in addition a smart use of restricted assets.
Can digital person-centred care provide a cheap resolution for psychological health-related sick depart in Sweden?
Strategies
The PROMISE trial was a non-blinded randomised managed trial carried out throughout 9 public main healthcare centres in Sweden from February 2018 to June 2020. Members have been adults on sick depart as a result of CMDs, with diagnoses of despair, nervousness, or stress-related issues. A complete of 206 people (>80% girls) have been enrolled and randomised into one among two teams: 100 members within the eHealth intervention + care as typical group, and 106 members within the care as typical group.
The intervention itself comprised a structured PCC delivered by healthcare professionals by way of cellphone 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. Typical care included GP consultations, remedy, psychological remedy, and rehabilitation providers.
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, each day actions, ache/discomfort, and despair/nervousness. Outcomes have been measured at baseline, 3, 6, and 12 months. Prices included healthcare utilisation, drug prices, and productiveness losses (sick depart days). Knowledge have been sourced from Swedish nationwide registries. The financial analysis employed incremental cost-effectiveness ratios (ICERs).
May a digital, professional-delivered, person-centred care intervention for adults on sick depart as a result of CMDs be less expensive than typical care over 12 months?
Outcomes
By way of cost-effectiveness, the examine discovered that:
- Members within the intervention group had barely increased QALYs (0.813) than these within the management group (0.807), reflecting a really small beneficial well being achieve.
- In the meantime, whole 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 individual.
- The ensuing ICER was SEK 23.8 million (£1,858,039.82) per QALY gained. Though this determine could 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 decreased drug prices and decrease productiveness losses. Specifically, sufferers within the intervention group used fewer non-antidepressant psychotropic drugs and had fewer sick depart days.
The intervention confirmed modest potential for cost-effectiveness, pushed primarily by decreased remedy use and fewer sick depart days.
Conclusions
The intervention seems possible, scalable, and even cost-saving, particularly when factoring in decreased remedy use and fewer sick depart days. However the well being achieve was minimal, and the excessive uncertainty round cost-effectiveness means it’s troublesome to advocate wide-scale adoption based mostly on this examine alone.
General, the result of this examine demonstrates a viable proof-of-concept: it exhibits that efficient and environment friendly person-centred psychological healthcare may be offered digitally, however the actual problem lies forward.
Strengths and limitations
The examine used a realistic design, applied in real-world main care settings in Sweden, enhancing the relevance of the findings to routine medical apply.
The inclusion of members with a spread of sick depart durations and CMD signs displays the medical variety present in real-world healthcare. An necessary power lies in its price evaluation, which included each direct healthcare prices (e.g., consultations, drugs) and broader societal prices similar to misplaced productiveness, offering precious 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 main care, notably in settings the place entry to psychological well being specialists is restricted. The researchers additionally examined the robustness of their findings below completely different analytical assumptions, strengthening the arrogance in the principle findings.
Nevertheless, you will need to 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 total, the small well being achieve means the ICER alone doesn’t imply the intervention ought to be adopted at a nationwide stage.
Moreover, the noticed QALY positive aspects have been minimal, elevating questions on whether or not the intervention meaningfully improved health-related high quality of life, even when it did assist scale back prices. Then again, whereas QALYs stay the gold customary for cost-effectiveness evaluations (Le et al., 2021), they could not absolutely 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 folks with widespread psychological issues, 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, probably incurring substantial prices that might alter the general cost-effectiveness.
The examine gives real-world insights into price and scalability; however modest well being positive aspects, unsure cost-effectiveness, and lack of digital platform price knowledge increase questions on wider implementation.
Implications for apply
The authors recommend key implications for apply and analysis based mostly on their findings:
- Digitally delivered person-centred care could provide a cheap method to supporting people on sick depart as a result of widespread psychological issues (CMDs), particularly when considered from a societal perspective that features productiveness loss.
- Additionally 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 circumstances, real-world implementation could face sensible challenges. These embody workers capability, variable engagement throughout suppliers, and digital entry and literacy boundaries 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 period of coaching could have decreased the intervention’s medical effectiveness, notably for members with extra advanced wants. Future analysis ought to look at whether or not extra intensive or tailor-made coaching might improve outcomes with out considerably growing prices.
- This examine additionally factors to a possible position for university-developed digital platforms in healthcare innovation. Nevertheless, long-term adoption could require integration with current IT infrastructure, knowledge 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. Nevertheless, the structured, person-centred mannequin used within the Swedish trial will not be but broadly applied. Integrating such an method into NHS Speaking Therapies or return-to-work providers would require funding in workforce coaching, digital infrastructure, and analysis of usability and accessibility throughout numerous populations. Nonetheless, the groundwork exists to adapt and pilot related 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
Main 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 offered by way of eHealth to scale back fatigue in sufferers with widespread psychological issues–secondary consequence evaluation from a randomized managed trial. Scandinavian Journal of Main Well being Care, 1-10.
Cederberg, M., Alsén, S., Ali, L., Ekman, I., Glise, Okay., Jonsdottir, I. H., … & Fors, A. (2022). Results of a person-centered eHealth intervention for sufferers on sick depart as a result of widespread psychological issues (PROMISE examine): open randomized managed trial. JMIR Psychological Well being, 9(3), e30966.
Ekman, I., Swedberg, Okay., Taft, C., Lindseth, A., Norberg, A., Brink, E., Carlsson, J., Dahlin-Ivanoff, S., Johansson, I.-L., Kjellgren, Okay., Lidén, E., Öhlén, J., Olsson, L.-E., Rosén, H., Rydmark, M., & Stibrant Sunnerhagen, Okay. (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 widespread psychological issues and long-term work incapacity: A 20-year longitudinal examine utilizing Swedish nationwide knowledge. 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 assessment. Frontiers in Well being Companies, 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, Okay., & Leineweber, C. (2025). Prognosis-specific sick depart and the position 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. Okay. 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 assessment of financial evaluations. PLoS medication, 18(5), e1003606.
