title: Economic evaluation of telephone-based concussion management for combat-related mild traumatic brain injury.
abstract: Introduction Mild traumatic brain injury (mTBI) is an unfortunately common repercussion of military service in a combat zone. The CONTACT study tested an individualized telephone support intervention employing problem solving therapy (PST) for mTBI in soldiers recently returned from deployment. We sought to determine the cost effectiveness of this intervention from a military healthcare system perspective. Methods We conducted an intent-to-treat post-hoc analysis by building a decision analytic model that evaluated the choice between using PST or education only (EO). The model included cost-minimization and cost-effectiveness analyses. The incremental cost-effectiveness ratios (ICERs) were calculated as the differences in costs of PST versus EO relative to the differences in the outcomes of participants. Results The PST intervention resulted in an annual per-enrolee cost of $1027 (95% CI: $836 to $1248), while EO costs were $32 (95% CI: $25 to $39), resulting in a net incremental cost of $996 per enrolee (95% CI: $806 to $1,217). The ICERs were $68,658/QALY based on EQ-5D (95% CI: -$463,535 to $596,661) and $49,284/QALY based on SF-6D (95% CI: $26,971 to $159,309). Estimates of treatment costs in a real-world setting were accompanied by substantially lower ICERs that are within accepted thresholds for willingness-to-pay. Discussion Although the intervention had short-term benefits sufficient to yield acceptable ICERs, there was no long-term effect of PST over EO observed in the study. Consequently, we suggest that future studies examine the use of low-cost approaches, such as booster relapse-prevention calls, that may lead to a sustained treatment benefit for this population.
authors.affiliation: 1 Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Richardson
authors.affiliation: 2 Department of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Guzauskas
authors.affiliation: 3 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.|4 Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Fann
authors.affiliation: 5 Department of Neurological Surgery, University of Washington, Seattle, WA, USA.|6 Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Temkin
authors.affiliation: 7 National Center for Telehealth and Technology, Joint Base Lewis-McChord, WA, USA.
authors.forename: Nigel E
authors.initials: NE
authors.lastname: Bush
authors.affiliation: 8 Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Bell
authors.affiliation: 7 National Center for Telehealth and Technology, Joint Base Lewis-McChord, WA, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Gahm
authors.affiliation: 7 National Center for Telehealth and Technology, Joint Base Lewis-McChord, WA, USA.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Smolenski
authors.affiliation: 4 Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Brockway
authors.affiliation: 2 Department of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Ryan N
authors.initials: RN
authors.lastname: Hansen
mesh_terms: D001924:Brain Concussion / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D006801:Humans; D008889:Military Personnel; D011340:Problem Solving; D019057:Quality-Adjusted Life Years; D013689:Telephone; D000067453:War Exposure
keywords: Cost effectiveness; cost minimization; telehealth