title: Economic evaluation of home-based telebehavioural health care compared to in-person treatment delivery for depression.
abstract: Introduction Home-based telebehavioural healthcare improves access to mental health care for patients restricted by travel burden. However, there is limited evidence assessing the economic value of home-based telebehavioural health care compared to in-person care. We sought to compare the economic impact of home-based telebehavioural health care and in-person care for depression among current and former US service members. Methods We performed trial-based cost-minimisation and cost-utility analyses to assess the economic impact of home-based telebehavioural health care versus in-person behavioural care for depression. Our analyses focused on the payer perspective (Department of Defense and Department of Veterans Affairs) at three months. We also performed a scenario analysis where all patients possessed video-conferencing technology that was approved by these agencies. The cost-utility analysis evaluated the impact of different depression categories on the incremental cost-effectiveness ratio. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model assumptions. Results In the base case analysis the total direct cost of home-based telebehavioural health care was higher than in-person care (US$71,974 versus US$20,322). Assuming that patients possessed government-approved video-conferencing technology, home-based telebehavioural health care was less costly compared to in-person care (US$19,177 versus US$20,322). In one-way sensitivity analyses, the proportion of patients possessing personal computers was a major driver of direct costs. In the cost-utility analysis, home-based telebehavioural health care was dominant when patients possessed video-conferencing technology. Results from probabilistic sensitivity analyses did not differ substantially from base case results. Discussion Home-based telebehavioural health care is dependent on the cost of supplying video-conferencing technology to patients but offers the opportunity to increase access to care. Health-care policies centred on implementation of home-based telebehavioural health care should ensure that these technologies are able to be successfully deployed on patients' existing technology.
authors.affiliation: 1 Department of Pharmacy, University of Washington, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bounthavong
authors.affiliation: 2 National Center for Telehealth and Technology (T2), USA.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Pruitt
authors.affiliation: 2 National Center for Telehealth and Technology (T2), USA.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Smolenski
authors.affiliation: 2 National Center for Telehealth and Technology (T2), USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Gahm
authors.affiliation: 1 Department of Pharmacy, University of Washington, USA.
authors.forename: Aasthaa
authors.initials: A
authors.lastname: Bansal
authors.affiliation: 1 Department of Pharmacy, University of Washington, USA.
authors.forename: Ryan N
authors.initials: RN
authors.lastname: Hansen
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000628:therapy*; D005260:Female; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D014481:United States; D014493:United States Department of Veterans Affairs; D049269:Videoconferencing / Q000191:economics / Q000458:organization & administration*
keywords: Cost analysis; cost minimisation; ehealth; home telecare; telecare