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Cost-effectiveness of telehealth for patients with depression: evidence from the Healthlines randomised controlled trial

  • Padraig Dixon (a1), Sandra Hollinghurst (a1), Louisa Edwards (a1), Clare Thomas (a1), Alexis Foster (a2), Ben Davies (a1), Daisy Gaunt (a3), Alan A. Montgomery (a3) (a4) and Chris Salisbury (a1)...
Abstract
Background

Depression is a prevalent long-term condition that is associated with substantial resource use. Telehealth may offer a cost-effective means of supporting the management of people with depression.

Aims

To investigate the cost-effectiveness of a telehealth intervention (‘Healthlines’) for patients with depression.

Method

A prospective patient-level economic evaluation conducted alongside a randomised controlled trial. Patients were recruited through primary care, and the intervention was delivered via a telehealth service. Participants with a confirmed diagnosis of depression and PHQ-9 score ≥10 were recruited from 43 English general practices. A series of up to 10 scripted, theory-led, telephone encounters with health information advisers supported participants to effect a behaviour change, use online resources, optimise medication and improve adherence. The intervention was delivered alongside usual care and was designed to support rather than duplicate primary care. Cost-effectiveness from a combined health and social care perspective was measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Cost–consequence analysis included cost of lost productivity, participant out-of-pocket expenditure and the clinical outcome.

Results

A total of 609 participants were randomised – 307 to receive the Healthlines intervention plus usual care and 302 to receive usual care alone. Forty-five per cent of participants had missing quality of life data, 41% had missing cost data and 51% of participants had missing data on either cost or utility, or both. Multiple imputation was used for the base-case analysis. The intervention was associated with incremental mean per-patient National Health Service/personal social services cost of £168 (95% CI £43 to £294) and an incremental QALY gain of 0.001 (95% CI −0.023 to 0.026). The incremental cost-effectiveness ratio was £132 630. Net monetary benefit at a cost-effectiveness threshold of £20 000 was –£143 (95% CI –£164 to –£122) and the probability of the intervention being cost-effective at this threshold value was 0.30. Productivity costs were higher in the intervention arm, but out-of-pocket expenses were lower.

Conclusions

The Healthlines service was acceptable to patients as a means of condition management, and response to treatment after 4 months was higher for participants randomised to the intervention. However, the positive average intervention effect size was modest, and incremental costs were high relative to a small incremental QALY gain at 12 months. The intervention is not likely to be cost-effective in its current form.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Padraig Dixon, Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. Email: Padraig.Dixon@bristol.ac.uk
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Declaration of interest

None.

Footnotes
References
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Cost-effectiveness of telehealth for patients with depression: evidence from the Healthlines randomised controlled trial

  • Padraig Dixon (a1), Sandra Hollinghurst (a1), Louisa Edwards (a1), Clare Thomas (a1), Alexis Foster (a2), Ben Davies (a1), Daisy Gaunt (a3), Alan A. Montgomery (a3) (a4) and Chris Salisbury (a1)...
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