A cost-effectiveness analysis of telemedicine and mobile health interventions to support continuing care for patients receiving treatment for alcohol use disorder

Andrew Quanbeck, PhD
University of Wisconsin-Madison

ABSTRACT:
This presentation reports the cost-effectiveness analysis from a fully powered randomized clinical trial that featured a head-to-head comparison between telemedicine and digital health interventions for providing continuing care for patients with alcohol use disorder. A telemedicine intervention (telephone monitoring and counseling: TMC) and a mobile health intervention (Alcohol Comprehensive Health Enhancement Support System: A-CHESS) were examined in a 2x2 factorial randomized trial that enrolled 262 participants from two Philadelphia area intensive outpatient programs. Intervention costs and effectiveness (in terms of number of risky drinking days) were assessed for each group with respect to the control group.

The effectiveness of reduced days heavy drinking for all 3 treatment groups (TMC, A-CHESS, and TMC+A-CHESS) were statistically significant compared to the control group. However, no treatment group was more effective than the others in terms of statistical significance. Compared to the control group, where participants averaged 43.75 days of heavy drinking over 12 months, participants in the treatment groups had significantly fewer average heavy drinking days over the 12-month intervention (TMC: 15.78 days heavy drinking, P<.001; A-CHESS: 17.83 days heavy drinking, P=.001; TMC+A-CHESS: 16.54 days heavy drinking, P<.001). Participants in the TMC, A-CHESS, and TMC+A-CHESS groups had an average of 31.62, 40.60, and 32.89 fewer days heavy drinking over the 12-month intervention compared to the control group, respectively, when adjusting for baseline rates of heavy drinking at the individual level. A-CHESS was slightly more expensive than TMC at a cost of $479 per patient vs. $434 for TMC; A-CHESS was also slightly more effective than TMC, and incremental cost-effectiveness ratios were comparable between the two interventions. In summary, using either A-CHESS or TMC both represented cost-effective intervention choices for providing continuing care to patients with alcohol use disorder. There was no clear evidence supporting the use of one intervention vs. the other. Rather, the decision about whether to use TMC or CHESS will depend (in part) on policymakers’ overall willingness to pay for reducing risky drinking in the populations they serve; further, pragmatic factors related to organizational context (including the socio-economic status of the patient population and overall size of the population served) may bear heavily on decision-makers’ preference for implementing TMC vs. A-CHESS.

The present study is the first to directly compare the cost-effectiveness of evidence-based mHealth and telemedicine approaches for the treatment of alcohol use treatment, and among the first studies in any domain of healthcare to feature a direct comparison between mHealth and telehealth modalities for chronic disease management.Results of this study may inform healthcare policymakers and decision makers on the costs and effects of telehealth and mHealth systems for reducing alcohol use and provide guidance on the most cost-effective approaches to incorporating technology-supported treatment into health care delivery systems for chronic disease management.