title: Trajectory of cost overtime after psychotherapy for depression in older Veterans via telemedicine.
abstract: Little evidence exists regarding the costs of telemedicine, especially considering changes over time. This analysis aimed to analyze trajectory of healthcare cost before, during, and after a behavioral activation intervention delivered via telepsychology and same-room delivery to elderly Veterans with depression.
  
  
  
  241 participants were randomly assigned into one of two study groups: behavioral activation for depression via telemedicine or via same-room treatment. Patients received 8 weeks of weekly 60-min individual sessions of behavioral activation for depression. Primary outcomes were collected at 12-months. Inpatient, outpatient, pharmacy, and total costs were collected from VA Health Economics Resource Center (HERC) datasets for FY 1998-2014 and compared between the two treatment groups. Generalized mixed models were used to investigate the trajectories over time.
  
  
  
  Overall cost, as well as, outpatient and pharmacy cost show increasing trend over time. Unadjusted and adjusted trajectories over time for any cost were not different between the two treatment groups. There was a significant overall increasing trend over time for outpatient (p<0.001) and total cost (p<0.001) but not for inpatient (p=0.543) or pharmacy cost (p=0.084).
  
  
  
  Generalizability to younger, healthier populations may be limited due to inclusion criteria for study participants.
  
  
  
  Healthcare costs before, during, and after intervention did not differ between the telemedicine and in-person delivery methods. Outpatient costs accounted for most of the increasing trend of cost over time. These results support policies to use both telehealth and in-person treatment modalities to effectively and efficiently provide high quality care.
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, United States. Electronic address: egedel@musc.edu.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Walker
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Payne
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; College of Nursing, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Ron
authors.initials: R
authors.lastname: Acierno
authors.affiliation: Department of Psychology, University of Hawaii, Hilo, HI, United States; Department of Psychology, The Menninger Clinic, Houston, TX, United States.
authors.forename: B Christopher
authors.initials: BC
authors.lastname: Frueh
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000191:economics / Q000628:therapy*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy / Q000191:economics / Q000379:methods*; D017216:Telemedicine / Q000191:economics* / Q000379:methods; D014481:United States; D058014:Veterans Health / Q000191:economics*
keywords: Behavioral activation; Cost; Depression; Elderly; Telemedicine; Telepsychology