Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.
Curr Med Res Opin. 2020 Sep;36(9):1541-1548. doi: 10.1080/03007995.2020.1790345. Epub 2020 Aug 7.
To determine the impact of telemental health (TMH) use on total healthcare costs and mental health (MH)-related costs paid by a third party among adults with mental health conditions (MHC).
This study employed a pre-post design with a non-equivalent control group. The cohort comprised adults with MHCs identified using diagnosis codes from de-identified claims data of the Optum Clinformatics DataMart (2010 January 01 to 2017 June 30). We identified mental health (MH) service users and TMH users ( = 348) based on procedure codes. Non-users ( = 238,595) were defined as those who only used in-person MH services. A Difference-in-Differences (DID) analysis was performed within a multivariable two-part model (TPM) framework to examine the impact of TMH use on adjusted standardized costs (2018 US $) of all healthcare services and MH services. Patient-level and state-level factors were adjusted in TPM.
TMH use was associated with significantly higher MH-related costs [Marginal effect = $461.3, 95% confidence interval: $142.4-$780.2] and an excess of $370 increase in MH-related costs at follow-up as compared to baseline. However, TMH use was not associated with an increase in total third-party healthcare costs nor with changes in total costs from baseline to follow-up.
Despite having a higher likelihood of MH services use and MH-related costs, TMH users did not have higher total costs as compared to adults using only in-person MH services. Our findings suggest that TMH can increase access to MH care without increasing total healthcare costs among adults with MHC. Future studies exploring whether TMH use can lead to cost-savings over a longer period are warranted.
确定在有心理健康状况（MHC）的成年人中，使用远程心理健康（TMH）对第三方支付的总医疗保健成本和心理健康（MH）相关成本的影响。
本研究采用前后设计，设有非等效对照组。队列由使用 Optum Clinformatics DataMart 中去识别索赔数据的诊断代码（2010 年 1 月 1 日至 2017 年 6 月 30 日）确定的 MHC 成年人组成。我们根据程序代码确定了 MH 服务使用者和 TMH 用户（ = 348）。非使用者（ = 238,595）被定义为仅使用面对面 MH 服务的人。在多变量两部分模型（TPM）框架内进行差异分析（DID），以检验 TMH 使用对所有医疗保健服务和 MH 服务调整后的标准化成本（2018 年美国美元）的影响。TPM 中调整了患者水平和州水平的因素。
TMH 使用与 MH 相关成本的显著增加相关[边际效应=461.3 美元，95%置信区间：142.4-780.2 美元]，与基线相比，随访时 MH 相关成本增加了 370 美元以上。然而，TMH 使用与第三方总医疗保健成本的增加无关，也与从基线到随访的总成本变化无关。
尽管 TMH 用户更有可能使用 MH 服务和 MH 相关成本，但与仅使用面对面 MH 服务的成年人相比，他们的总费用并没有增加。我们的研究结果表明，TMH 可以在增加 MHC 成年人获得 MH 护理的机会的同时，不增加总医疗保健成本。需要进一步研究 TMH 使用是否可以在较长时间内节省成本。
