JMIR Publications

Background:

The COVID-19 pandemic accelerated the adoption of telehealth for psychological services in Australia. While early evidence supported the feasibility of telehealth, limited data exist on its long-term economic value, particularly in comparison to in-person care and no-treatment options. Existing evaluations often overlook societal costs and clinical equivalence assumptions.

Objective:

To evaluate the cost-effectiveness and budget impact of telehealth-delivered psychological services by clinical psychologists in Australia, compared with in-person care and no treatment, from both the healthcare payer and societal perspectives.

Methods:

A model-based economic evaluation was conducted using a Markov cohort model over a 5-year time horizon. The model simulated transitions across five psychological health states (minimal, mild, moderate, severe symptoms, and death) based on published clinical effectiveness data. Three strategies were compared: (i) No treatment; (ii) In-person psychological services; and (II) Telehealth services (including video and phone). The analysis adopted both healthcare payer and societal perspectives, incorporating direct healthcare costs and productivity losses. Health outcomes were expressed as quality-adjusted life years (QALYs). Cost-minimisation analysis (CMA) was used to compare telehealth and in-person care, based on evidence of clinical equivalence. Incremental cost-effectiveness ratios (ICERs) were calculated only when comparing active treatment to no treatment. Model inputs were drawn from peer-reviewed literature, government sources, and national Medicare Benefits Schedule (MBS) claims data (April 2020–June 2022). Sensitivity analyses (deterministic and probabilistic) and budget impact analysis (BIA) were conducted.

Results:

Compared with no treatment, both telehealth and in-person psychological services were highly cost-effective, with incremental cost-effectiveness ratios (ICERs) of AU $3,213 and AU $8,760 per quality-adjusted life year (QALY) gained, respectively, from the healthcare payer perspective. From a societal perspective, telehealth was the dominant strategy, achieving equivalent health outcomes to in-person care at lower overall cost. Cost-minimisation analysis showed that telehealth saved AU $28.9 million over five years compared to in-person delivery. Probabilistic sensitivity analysis demonstrated the robustness of these findings, with telehealth being cost-effective in 100% of simulations at a willingness-to-pay threshold of AU $50,000 per QALY. The five-year budget impact of implementing unrestricted telehealth services was estimated at AU $152.7 million, corresponding to AU $1.40 per member per month. These results remained stable across variations in service uptake, wage assumptions, and population growth.

Conclusions:

Telehealth psychological services are cost-saving and clinically equivalent to in-person care, supporting their continued use beyond the pandemic. These findings inform evidence-based policy on mental healthcare access, equity, and investment in telehealth infrastructure.

Clinicaltrial: