Online ISSN: 1099-176X Print
Copyright © 2013 ICMPE.
Economic Analysis of an Internet-Based Depression Prevention Intervention
Alexander Ruby,1 Monika Marko-Holguin,2 Joshua Fogel,3 Benjamin W. Van Voorhees4
Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
Correspondence to: Benjamin Van Voorhees, MD, MPH,
Department of Pediatrics, Associate Professor and Chief Section of, General
Pediatrics and Adolescent Medicine, University of Illinois at Chicago, 840
South Wood Street, M/C 856, Chicago, IL 60612.
Tel.: +1-312-996 0023
Fax: +1-312-413 0243
Source of Funding: NARSAD, RWJ, NIMH K-08 MH 072918-01A2 and NIH/NCRR CTSA UL1 RR024999.
Background: The transition through adolescence places adolescents at increased risk of depression, yet care-seeking in this population is low, and treatment is often ineffective. In response, we developed an Internet-based depression prevention intervention (CATCH-IT) targeting at-risk adolescents.
Aims of the Study: We explore CATCH-IT program costs, especially safety costs, in the context of an Accountable Care Organization as well as the perceived value of the Internet program.
Methods: Total and per-patient costs of development were calculated using an assumed cohort of a 5,000-patient Accountable Care Organization. Total and per-patient costs of implementation were calculated from grant data and the Medicare Resource-Based Relative Value Scale (RBRVS) and were compared to the willingness-to-pay for CATCH-IT and to the cost of current treatment options. The cost effectiveness of the safety protocol was assessed using the number of safety calls placed and the percentage of patients receiving at least one safety call. The willingness-to-pay for CATCH-IT, a measure of its perceived value, was assessed using post-study questionnaires and was compared to the development cost for a break-even point.
Results: We found the total cost of developing the intervention to be $138,683.03. Of the total, 54% was devoted to content development with per patient cost of $27.74. The total cost of implementation was found to be $49,592.25, with per patient cost of $597.50. Safety costs accounted for 35% of the total cost of implementation. For comparison, the cost of a 15-session group cognitive behavioral therapy (CBT) intervention aimed at at-risk adolescents was $1,632 per patient. Safety calls were successfully placed to 96.4% of the study participants. The cost per call was $40.51 with a cost per participant of $197.99. The willingness-to-pay for the Internet portion of CATCH-IT had a median of $40. The break-even point to offset the cost of development was 3,468 individuals.
Discussion and Limitations: Developing Internet-based interventions like CATCH-IT appears economically viable in the context of an Accountable Care Organization. Furthermore, while the cost of implementing an effective safety protocol is proportionally high for this intervention, CATCH-IT is still significantly cheaper to implement than current treatment options. Limitations of this research included diminished participation in follow-up surveys assessing willingness-to-pay.
Implications for Health Care Provision and Use and Health Policies: This research emphasizes that preventive interventions have the potential to be cheaper to implement than treatment protocols, even before taking into account lost productivity due to illness. Research such as this business application analysis of the CATCH-IT program highlights the importance of supporting preventive medical interventions as the healthcare system already does for treatment interventions.
Implications for Further Research: This research is the first to analyze the economic costs of an Internet-based intervention. Further research into the costs and outcomes of such interventions is certainly warranted before they are widely adopted. Furthermore, more research regarding the safety of Internet-based programs will likely need to be conducted before they are broadly accepted.
13 May 2013; accepted 26 July 2013
Copyright © 2013 ICMPE