Ruby Alexander, Marko-Holguin Monika, Fogel Joshua, Van Voorhees Benjamin W
Department of Pediatrics, General Pediatrics and Adolescent Medicine, University of Illinois at Chicago, 840 South Wood Street, M/C 856, Chicago, IL 60612,
J Ment Health Policy Econ. 2013 Sep;16(3):121-30.
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.
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.
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.
We found the total cost of developing the intervention to be USD 138,683.03. Of the total, 54% was devoted to content development with per patient cost of USD 27.74. The total cost of implementation was found to be USD 49,592.25, with per patient cost of USD 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 USD 1,632 per patient. Safety calls were successfully placed to 96.4% of the study participants. The cost per call was USD 40.51 with a cost per participant of USD 197.99. The willingness-to-pay for the Internet portion of CATCH-IT had a median of USD 40. The break-even point to offset the cost of development was 3,468 individuals.
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.
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.
青春期过渡使青少年患抑郁症的风险增加，但该人群寻求治疗的比例较低，且治疗往往效果不佳。作为应对措施，我们开发了一种针对高危青少年的基于互联网的抑郁症预防干预措施（CATCH-IT）。
我们在 accountable care organization 的背景下探讨 CATCH-IT 项目的成本，特别是安全成本，以及互联网项目的感知价值。
使用一个假设的 5000 名患者的 accountable care organization 队列计算开发的总成本和每位患者的成本。实施的总成本和每位患者的成本根据拨款数据和医疗保险基于资源的相对价值量表（RBRVS）计算，并与 CATCH-IT 的支付意愿以及当前治疗选择的成本进行比较。使用拨打的安全电话数量和至少接到一次安全电话的患者百分比评估安全协议的成本效益。使用研究后的调查问卷评估 CATCH-IT 的支付意愿（其感知价值的一种衡量方式），并与开发成本进行比较以确定收支平衡点。
我们发现开发该干预措施的总成本为 138,683.03 美元。其中，54%用于内容开发，每位患者的成本为 27.74 美元。实施的总成本为 49,592.25 美元，每位患者的成本为 597.50 美元。安全成本占实施总成本的 35%。相比之下，针对高危青少年的 15 节小组认知行为疗法（CBT）干预措施每位患者的成本为 1632 美元。成功向 96.4%的研究参与者拨打了安全电话。每次通话的成本为 40.51 美元，每位参与者的成本为 197.99 美元。CATCH-IT 互联网部分的支付意愿中位数为 40 美元。抵消开发成本的收支平衡点是 3468 人。
在 accountable care organization 的背景下，开发像 CATCH-IT 这样的基于互联网的干预措施在经济上似乎是可行的。此外，虽然实施有效的安全协议的成本对于该干预措施来说相对较高，但 CATCH-IT 的实施成本仍比当前治疗选择便宜得多。这项研究的局限性包括评估支付意愿的后续调查参与度降低。对医疗保健提供与使用以及卫生政策的启示：这项研究强调，即使不考虑因病导致的生产力损失，预防性干预措施的实施成本可能比治疗方案更低。像对 CATCH-IT 项目的这种商业应用分析这样的研究凸显了支持预防性医疗干预措施的重要性，就像医疗保健系统对治疗干预措施所做的那样。
这项研究是首次分析基于互联网的干预措施的经济成本。在这些干预措施被广泛采用之前，对其成本和结果进行进一步研究当然是必要的。此外，在基于互联网的项目被广泛接受之前，可能还需要进行更多关于其安全性的研究。
