Telemedicine: a cost-reducing means of delivering psychotherapy to rural combat veterans with PTSD.
BACKGROUND
Although effective psychotherapies for posttraumatic stress disorder (PTSD) exist, high percentages of Veterans in need of services are unable to access them. One particular challenge to providing cost-effective psychological treatments to Veterans with PTSD involves the difficulty and high cost of delivering in-person, specialized psychotherapy to Veterans residing in geographically remote locations. The delivery of these services via clinical videoteleconferencing (CVT) has been presented as a potential solution to this access to care problem.


METHODS
This study is a retrospective cost analysis of a randomized controlled trial investigating telemedicine service delivery of an anger management therapy for Veterans with PTSD. The parent trial found that the CVT condition provided clinical results that were comparable to the in-person condition. Several cost outcomes were calculated in order to investigate the clinical and cost outcomes associated with the CVT delivery modality relative to in-person delivery.


RESULTS
The CVT condition was significantly associated with lower total costs compared with the in-person delivery condition. The delivery of mental health services via CVT enables Veterans who would not normally receive these services access to empirically based treatments. Additional studies addressing long-term healthcare system costs, indirect cost factors at the patient and societal levels, and the use of CVT in other geographic regions of the United States are needed.


CONCLUSIONS
The results of this study provide evidence that CVT is a cost-reducing mode of service delivery to Veterans with PTSD relative to in-person delivery.
1 Pacific Islands Division, National Center for PTSD, Department of Veterans Affairs Pacific Islands Healthcare System , Honolulu, Hawaii.
Leslie A
LA
Morland
Michelle
M
Raab
Margaret-Anne
MA
Mackintosh
Craig S
CS
Rosen
Clara E
CE
Dismuke
Carolyn J
CJ
Greene
B Christopher
BC
Frueh
D003363:Cost Control; D003362:Cost-Benefit Analysis; D006254:Hawaii; D006801:Humans; D008297:Male; D011613:Psychotherapy / Q000191:economics*; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D017216:Telemedicine / Q000191:economics*; D014728:Veterans / Q000523:psychology*