Common mental disorders (CMDs), including depression, anxiety, and stress-related conditions, are major contributors to global disability and sickness absence. In Sweden, they account for a significant share of long-term sick leave, affecting both individual wellbeing and national productivity (Helgesson et al., 2025; Falkenberg et al., 2025).
As digital health services expand, interest is growing in their potential to deliver person-centred care (PCC) at scale. PCC promotes a collaborative approach that centres on patients’ values, goals, and capabilities, rather than just symptom relief (Ekman et al., 2011; Forsgren et al., 2025).
The PROMISE trial, conducted in Sweden, tested a digitally delivered PCC intervention for individuals on sick leave due to CMDs (Cederberg et al., 2022). Early findings have shown reductions in fatigue (Alsen, 2025).
Kebede et al. (2025) evaluated the cost-effectiveness of the PROMISE intervention, seeking to answer whether the intervention is not just clinically helpful, but also a sensible use of limited resources.
Can digital person-centred care offer a cost-effective solution for mental health-related sick leave in Sweden?
Methods
The PROMISE trial was a non-blinded randomised controlled trial carried out across nine public primary healthcare centres in Sweden from February 2018 to June 2020. Participants were adults on sick leave due to CMDs, with diagnoses of depression, anxiety, or stress-related disorders. A total of 206 individuals (>80% women) were enrolled and randomised into one of two groups: 100 participants in the eHealth intervention + care as usual group, and 106 participants in the care as usual group.
The intervention itself comprised a structured PCC delivered by healthcare professionals via phone and a secure web-based platform and included:
- an initial person-centred conversation
- the development of a personalised health plan, and
- ongoing digital support.
The healthcare professionals who delivered the intervention included nurses, a physiotherapist, and an occupational therapist who received a half-day training in CMDs from psychologists and physicians, and additional training in PCC philosophy from researchers in relevant fields, supported by reflective forums with PCC specialists throughout the intervention. The digital platform was developed by the University of Gothenburg and allowed patients to track progress and maintain communication with providers. Usual care included GP consultations, medication, psychological therapy, and rehabilitation services.
The primary health outcome for the cost-effectiveness analysis was quality-adjusted life years (QALYs), calculated using the EQ-5D-3L instrument which assesses five dimensions of health-related quality of life: mobility, self-care, daily activities, pain/discomfort, and depression/anxiety. Outcomes were measured at baseline, 3, 6, and 12 months. Costs included healthcare utilisation, drug costs, and productivity losses (sick leave days). Data were sourced from Swedish national registries. The economic evaluation employed incremental cost-effectiveness ratios (ICERs).
Could a digital, professional-delivered, person-centred care intervention for adults on sick leave due to CMDs be more cost-effective than usual care over 12 months?
Results
In terms of cost-effectiveness, the study found that:
- Participants in the intervention group had slightly higher QALYs (0.813) than those in the control group (0.807), reflecting a very small favourable health gain.
- Meanwhile, total societal costs were lower in the intervention group, at 183,352 Swedish Krona (SEK) per patient (£14,314.09), compared to SEK 203,648 (£15,898.58) in the control group, a mean saving of SEK 20,296 (£1,584.49) per person.
- The resulting ICER was SEK 23.8 million (£1,858,039.82) per QALY gained. Although this figure may appear high, probabilistic sensitivity analysis indicated a 76.3% likelihood that the intervention was cost-effective within Sweden’s willingness-to-pay threshold.
- Cost savings were primarily attributed to reduced drug costs and lower productivity losses. In particular, patients in the intervention group used fewer non-antidepressant psychotropic medications and had fewer sick leave days.
The intervention showed modest potential for cost-effectiveness, driven mainly by reduced medication use and fewer sick leave days.
Conclusions
The intervention appears feasible, scalable, and even cost-saving, especially when factoring in reduced medication use and fewer sick leave days. But the health gain was minimal, and the high uncertainty around cost-effectiveness means it’s difficult to recommend wide-scale adoption based on this study alone.
Overall, the outcome of this study demonstrates a viable proof-of-concept: it shows that effective and efficient person-centred mental healthcare can be provided digitally, but the real challenge lies ahead.
Strengths and limitations
The study used a pragmatic design, implemented in real-world primary care settings in Sweden, enhancing the relevance of the findings to routine clinical practice.
The inclusion of participants with a range of sick leave durations and CMD symptoms reflects the clinical diversity found in real-world healthcare. An important strength lies in its cost analysis, which included both direct healthcare costs (e.g., consultations, medications) and broader societal costs such as lost productivity, providing valuable insights for policymakers weighing system-wide benefits. The feasibility of the intervention also lies in it being delivered by non-specialist healthcare professionals, including registered nurses. This supports its scalability in primary care, particularly in settings where access to mental health specialists is limited. The researchers also tested the robustness of their findings under different analytical assumptions, strengthening the confidence in the main findings.
However, it is important to consider that the cost-effectiveness results were highly variable, as reflected in a very high incremental cost-effectiveness ratio of SEK 23.8 million (£1,858,039.82) per QALY gained. Although the intervention was cost-saving overall, the small health gain means the ICER alone does not mean the intervention should be adopted at a national level.
Additionally, the observed QALY gains were minimal, raising questions about whether the intervention meaningfully improved health-related quality of life, even if it did help reduce costs. On the other hand, while QALYs remain the gold standard for cost-effectiveness evaluations (Le et al., 2021), they may not fully capture the impact of mental health interventions, especially those focused on work participation and recovery (Franklin & Alava, 2023).
The follow-up period was limited to 12 months, which may not be long enough to fully capture health and economic outcomes for people with common mental disorders, especially regarding return-to-work trajectories or sustained improvements in wellbeing. In addition, the intervention relied on a digital platform developed by a Swedish university, but the cost of building, implementing, and maintaining this platform was not included in the economic analysis. If adopted at scale, new or adapted digital tools may be required, potentially incurring substantial costs that could alter the overall cost-effectiveness.
The study offers real-world insights into cost and scalability; but modest health gains, uncertain cost-effectiveness, and lack of digital platform cost data raise questions about wider implementation.
Implications for practice
The authors suggest key implications for practice and research based on their findings:
- Digitally delivered person-centred care may offer a cost-effective approach to supporting individuals on sick leave due to common mental disorders (CMDs), especially when viewed from a societal perspective that includes productivity loss.
- They also highlight the potential for this model to enhance continuity and coordination in care, especially when healthcare professionals are able to form collaborative, goal-oriented relationships with patients over time.
Beyond the authors’ recommendations, there are important implications that researchers, policymakers and healthcare providers should consider:
- Future studies should consider complementary measures, such as capability or work functioning outcomes, which may better reflect the impact of CMDs and recovery in working-age adults.
- Although the intervention demonstrated cost savings and feasibility under trial conditions, real-world implementation may face practical challenges. These include staff capacity, variable engagement across providers, and digital access and literacy barriers for some patients. Future research should explore these factors, including training and supervision models, to support sustainable delivery at scale.
- While the intervention’s delivery by non-specialist healthcare professionals makes it scalable and cost-efficient, the limited duration of training may have reduced the intervention’s clinical effectiveness, particularly for participants with more complex needs. Future research should examine whether more intensive or tailored training could enhance outcomes without substantially increasing costs.
- This study also points to a potential role for university-developed digital platforms in healthcare innovation. However, long-term adoption may require integration with existing IT infrastructure, data governance, and user experience design, which are not captured in cost-effectiveness analyses.
- The NHS is already investing in e-mental health interventions, including Digitally Enabled Therapies (DETs), NHS-approved apps (e.g. SilverCloud, Sleepio), and AI-driven triage tools. However, the structured, person-centred model used in the Swedish trial is not yet widely implemented. Integrating such an approach into NHS Talking Therapies or return-to-work services would require investment in workforce training, digital infrastructure, and evaluation of usability and accessibility across diverse populations. Still, the groundwork exists to adapt and pilot similar models within the UK health system.
Digitally delivered person-centred care could be scalable, but will require investment in training, digital infrastructure, and outcome measures that better capture mental health recovery.
Statement of interests
I have no competing interests to declare.
Links
Primary paper
Kebede TT, Cederberg M, Alsén S, Fors A, Gyllensten H. A Person-Centered eHealth Intervention for Patients With Common Mental Disorders: Cost-Effectiveness Analysis Within a Randomized Controlled Trial. Value Health. 2025 Jun;28(6):875-883. doi: 10.1016/j.jval.2025.03.011. Epub 2025 Apr 10. PMID: 40220864.
Other references
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Cederberg, M., Alsén, S., Ali, L., Ekman, I., Glise, K., Jonsdottir, I. H., … & Fors, A. (2022). Effects of a person-centered eHealth intervention for patients on sick leave due to common mental disorders (PROMISE study): open randomized controlled trial. JMIR Mental Health, 9(3), e30966.
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Franklin, M., & Hernández Alava, M. (2023). Enabling QALY estimation in mental health trials and care settings: mapping from the PHQ-9 and GAD-7 to the ReQoL-UI or EQ-5D-5L using mixture models. Quality of Life Research, 32(10), 2763-2778.
Helgesson, M., Gustafsson, K., & Leineweber, C. (2025). Diagnosis-specific sick leave and the role of a national return-to-work program: A population-based matched cohort study. Journal of Occupational Rehabilitation, 35(2), 263–274. https://doi.org/10.1007/s10926-025-10269-4
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