Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Jun 09, 2020)
Date Submitted: May 1, 2019
Open Peer Review Period: May 6, 2019 - Jul 1, 2019
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Cost and cost-effectiveness of StepCare: A stepped mental health care service in Australian general practice.
Background:
The online ‘StepCare’ Service identifies adults with common mental disorders, recommends evidence-based treatments and monitors symptoms and risk, with feedback to patient and GP. Proof of concept study data indicated that the Service is acceptable and feasible in general practice.
Objective:
As part of a larger implementation study of StepCare, we conducted an economic evaluation of the Service from multiple stakeholder perspectives. The economic evaluation included (1) a trial-based cost and cost effectiveness analysis and (2) a modelled cost-consequence analysis. An Australian public finance perspective was used, with costs disaggregated to give transparency to the investment contributed by the various stakeholders.
Methods:
General practices, GPs, practice staff and adult patients (18 years and over) in two large Australian Primary Health Networks (PHNs), one urban, the other rural/remote, were invited to take part in the full implementation study. For the trial-based analysis, an incremental cost-effectiveness ratio (ICER) was calculated based on one of two metrics identified as appropriate proxy measures for better alignment with stepped mental health care: GP diagnosis rate for anxiety and depression. The expected costs over a twelve-month period associated with usual practice compared to a fully implemented stepped care model were calculated in the modelled extrapolation.
Results:
The trial-based analyses calculated the incremental cost of implementing StepCare to be $54 per person screened, with a cost per newly diagnosed person of $10,750. The modelled evaluation calculated that over a 12 month period, the StepCare Service (screening and treatment) was associated with mean costs of $294 AUD per person compared to (i) usual care assuming no active screening and a quasi-stepped approach to treatment, costing a mean of $535 AUD per person and (ii) usual care assuming no active screening and treatment-as-usual (ie not quasi-stepped) costing a mean of $442 AUD per person. That is, StepCare was associated with lower costs than either of the two comparator scenarios.
Conclusions:
Compared to current mental health care in general practice, StepCare is a cost-effective screening and patient management tool.
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