Economic evaluation of home-based telebehavioural health care compared to in-person treatment delivery for depression

J Telemed Telecare. 2018 Feb;24(2):84-92. doi: 10.1177/1357633X16678147. Epub 2016 Nov 12.

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.

Keywords: Cost analysis; cost minimisation; ehealth; home telecare; telecare.

MeSH terms

  • Adult
  • Behavior Therapy / economics*
  • Behavior Therapy / methods*
  • Cost-Benefit Analysis
  • Depression / therapy*
  • Female
  • Home Care Services / economics
  • Home Care Services / organization & administration*
  • Humans
  • Male
  • Middle Aged
  • Military Personnel
  • United States
  • United States Department of Veterans Affairs
  • Videoconferencing / economics
  • Videoconferencing / organization & administration*