Cost-Effectiveness of Telemedicine-Based Collaborative Care for Posttraumatic Stress Disorder.

OBJECTIVE: The study examined the cost-effectiveness of a telemedicine-based collaborative care model designed to increase rural veterans' engagement in evidence-based treatments for posttraumatic stress disorder (PTSD).

METHODS: The Telemedicine Outreach for PTSD (TOP) study used a pragmatic randomized effectiveness trial to examine effects of PTSD care teams located at Veterans Affairs medical centers and supporting primary care providers in satellite clinics. Teams included a nurse care manager, pharmacist, psychologist, and psychiatrist. Effectiveness was estimated with quality-adjusted life years (QALYs) derived from the Short Form Health Survey for Veterans and Quality of Well-Being (QWB) scale. Intervention and health care costs were collected to evaluate the cost-effectiveness of the intervention.

RESULTS: The sample (N=265) included mostly rural, unemployed, middle-aged men with a military service-connected disability for PTSD randomly assigned to TOP or usual care. Only minor improvements in QWB QALYs were found. The TOP intervention was relatively expensive, with costs totaling $2,029 per patient per year. Intervention costs were not offset by reductions in health care utilization costs, resulting in an incremental cost-effectiveness ratio of $185,565 per QALY (interquartile range $57,675 to $395,743).

CONCLUSIONS: Because of the upfront training costs and the resource-intensive nature of this intervention, associated expenses were high. Although PTSD-specific effectiveness measures were significantly improved, these changes did not translate to QALYs in the main analysis. However, analyses focusing on patient subgroups with comorbid mental disorders indicated greater QALY improvement for TOP at lower cost.