Trajectory of cost overtime after psychotherapy for depression in older Veterans via telemedicine

- There is limited data on trajectories of total and component costs for telemental interventions.
- Pre treatment and post treatment costs were compared in 201 subjects randomized to telemedicine vs. same-room.
- Overall cost, as well as, outpatient and pharmacy cost showed increasing trend over time in both groups.
- Costs before, during, and after intervention did not differ between the telemedicine and same-room groups.
- Outpatient costs accounted for most of the increasing trend of cost over time.

BackgroundLittle evidence exists regarding the costs of telemedicine, especially considering changes over time. This analysis aimed to analyze trajectory of healthcare cost before, during, and after a behavioral activation intervention delivered via telepsychology and same-room delivery to elderly Veterans with depression.Methods241 participants were randomly assigned into one of two study groups: behavioral activation for depression via telemedicine or via same-room treatment. Patients received 8 weeks of weekly 60-min individual sessions of behavioral activation for depression. Primary outcomes were collected at 12-months. Inpatient, outpatient, pharmacy, and total costs were collected from VA Health Economics Resource Center (HERC) datasets for FY 1998-2014 and compared between the two treatment groups. Generalized mixed models were used to investigate the trajectories over time.ResultsOverall cost, as well as, outpatient and pharmacy cost show increasing trend over time. Unadjusted and adjusted trajectories over time for any cost were not different between the two treatment groups. There was a significant overall increasing trend over time for outpatient (p<0.001) and total cost (p<0.001) but not for inpatient (p=0.543) or pharmacy cost (p=0.084).LimitationsGeneralizability to younger, healthier populations may be limited due to inclusion criteria for study participants.ConclusionHealthcare costs before, during, and after intervention did not differ between the telemedicine and in-person delivery methods. Outpatient costs accounted for most of the increasing trend of cost over time. These results support policies to use both telehealth and in-person treatment modalities to effectively and efficiently provide high quality care.