title: Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a health economic modeling study.
abstract: OBJECTIVE
  Depressive disorders are significant causes of disease burden and are associated with substantial economic costs. It is therefore important to design a healthcare system that can effectively manage depression at sustainable costs. This article computes the benefit-to-cost ratio of the current Dutch healthcare system for depression, and investigates whether offering more online preventive interventions improves the cost-effectiveness overall.
  
  
  METHODS
  A health economic (Markov) model was used to synthesize clinical and economic evidence and to compute population-level costs and effects of interventions. The model compared a base case scenario without preventive telemedicine and alternative scenarios with preventive telemedicine. The central outcome was the benefit-to-cost ratio, also known as return-on-investment (ROI).
  
  
  RESULTS
  In terms of ROI, a healthcare system with preventive telemedicine for depressive disorders offers better value for money than a healthcare system without Internet-based prevention. Overall, the ROI increases from €1.45 ($1.72) in the base case scenario to €1.76 ($2.09) in the alternative scenario in which preventive telemedicine is offered. In a scenario in which the costs of offering preventive telemedicine are balanced by reducing the expenditures for curative interventions, ROI increases to €1.77 ($2.10), while keeping the healthcare budget constant.
  
  
  CONCLUSIONS
  For a healthcare system for depressive disorders to remain economically sustainable, its cost-benefit ratio needs to be improved. Offering preventive telemedicine at a large scale is likely to introduce such an improvement.
authors.affiliation: Trimbos Institute (The Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Clinical Psychology, VU University, Amsterdam, The Netherlands. Electronic address: jlokkerbol@trimbos.nl.
authors.forename: Joran
authors.initials: J
authors.lastname: Lokkerbol
authors.affiliation: Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
authors.forename: Dirk
authors.initials: D
authors.lastname: Adema
authors.affiliation: Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Richard
authors.initials: R
authors.lastname: Schulz
authors.affiliation: European Science Foundation, Strasbourg, France.
authors.forename: Rifka
authors.initials: R
authors.lastname: Weehuizen
authors.affiliation: Trimbos Institute (The Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
mesh_terms: D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics* / Q000517:prevention & control* / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D008605:Mental Health Services / Q000191:economics*; D018803:Models, Economic; D017216:Telemedicine / Q000191:economics*
keywords: Cost-benefit analysis; depressive disorder; e-health; health economic modeling; prevention