JMIR Publications

ABSTRACT

Background:

Task-shared depression care supported by quality assurance approaches, such as peer supervision, has the potential to address the treatment gap in depression care. However, scaling and sustaining task-shared depression care requires practical, affordable solutions. Shared, web-based training platforms offer promise, yet a more detailed understanding of costs for implementation and ongoing delivery is needed to inform their adoption and sustainability within health systems.

Objective:

This study presents a costing exercise of the implementation of a digitally-supported Measurement-Based Peer Supervision (MBPS) program for a task-shared behavioral activation intervention for depression.

Methods:

We estimated the cost of usage of a web-based MPBS application using a bottom-up, time-driven activity-based costing approach that identified activities associated with usage. Costs were estimated from the perspective of the implementing health system. For each identified activity, we estimated frequency, time per each occurrence, and required personnel and their associated costs. We estimated other fixed costs and presented our results across four modeled implementation scenarios in which the number of providers (25 and 50 non-specialist providers) and length of time (6- and 12-months) of application usage varied. We also presented the formula we used to enable future organizations to estimate costs tailored to their specific implementation model and settings.

Results:

Total digitally-assisted MBPS program costs ranged from US $29,940 (6 months, 25 providers) to US $104,054 (12 months, 50 providers). Human resources on the implementer side accounted for 80% to 88.5% of total costs, driven primarily by provider time spent reviewing and rating recorded Behavioral Activation sessions and participating in supervision. Technology costs (platform subscription and licensing at US $1000 per month) represented 11.3%–20% of total costs. Increasing either the number of providers or the implementation period raised total costs proportionally. The total cost per patient was similar across each scenario as we increased the length of implementation period and number of providers ($208.12 to $255.72). We derived a generalizable formula that allows organizations to input key parameters (number of providers, patients, sessions, supervision frequency, wages, and months of platform use) to estimate MBPS-related costs.

Conclusions:

Our study has implications for guiding implementing organizations and health payors seeking to deliver task-shared psychological interventions, such as behavioral activation, for depression. Human resource costs accounted for the majority of costs incurred, most of which are inherent to the peer supervision model rather than to the application itself. While some activities require human-led coordination and management (e.g., session management), automation of other regular tasks may potentially provide cost savings opportunities. Future research should examine the cost-effectiveness of an MBPS application and compare cost savings for task-shared depression care with and without the MBPS application. Clinical Trial: ClinicalTrials.gov NCT07082010, registered July 24, 2025 at https://clinicaltrials.gov/study/NCT07082010