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

Padraig Dixon, Sandra Hollinghurst, Louisa Edwards, Clare Thomas, Alexis Foster, Ben Davies, Daisy Gaunt, Alan Montgomery, Chris Salisbury

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Objectives: To investigate the cost-effectiveness of a telehealth intervention (‘Healthlines’) for patients with depression.
Design: A prospective patient-level economic evaluation conducted alongside a randomised controlled trial. 
Setting: Patients recruited through primary care, and intervention delivered via a telehealth service.
Participants: Participants with a confirmed diagnosis of depression and PHQ-9 score≥10 were recruited from 43 English general practices.
Intervention: A series of up to 10 scripted, theory-led, telephone encounters with Health Information Advisers that supported participants to make 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. 
Primary and secondary outcome measures: Cost-effectiveness from a combined health and social care perspective 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-consequences analysis included cost of lost productivity, participant out-of-pocket expenditure, and the clinical outcome.
Results: 609 participants were randomised – 307 to receive the Healthlines intervention plus usual care and 302 to receive usual care alone. 45% of participants had missing quality of life data, 41% had missing cost data, and together 51% of participants had missing data on either cost data, utility data, or both. Multiple imputation was used for the base case analysis. The intervention was associated with incremental mean per-patient NHS 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 that the intervention would be cost-effective at this threshold value was 0.30. Productivity costs were higher in the intervention arm, but out-of-pocket expenses lower. 
Conclusions: The Healthlines service was found to be acceptable to patients as a means of condition management, and response to treatment after four 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. 
Trial registration: ISRCTN14172341, prospectively registered on 26/06/2012.
Original languageEnglish
Pages (from-to)262-269
Number of pages8
JournalBJPsych Open
Volume2
Issue number4
DOIs
Publication statusPublished - 9 Aug 2016

Structured keywords

  • BTC (Bristol Trials Centre)
  • BRTC

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