Economic evaluation of telephone-based concussion management for combat-related mild traumatic brain injury

John S. Richardson, Gregory F. Guzauskas, Jesse R. Fann, Nancy R. Temkin, Nigel E. Bush, Kathleen R. Bell, Gregory A. Gahm, Derek J. Smolenski, Jo Ann Brockway, Ryan N. Hansen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Mild traumatic brain injury (mTBI) is an unfortunately common repercussion of military service in a combat zone. The CONTACT study tested an individualized telephone support intervention employing problem solving therapy (PST) for mTBI in soldiers recently returned from deployment. We sought to determine the cost effectiveness of this intervention from a military healthcare system perspective. Methods: We conducted an intent-to-treat post-hoc analysis by building a decision analytic model that evaluated the choice between using PST or education only (EO). The model included cost-minimization and cost-effectiveness analyses. The incremental cost-effectiveness ratios (ICERs) were calculated as the differences in costs of PST versus EO relative to the differences in the outcomes of participants. Results: The PST intervention resulted in an annual per-enrolee cost of $1027 (95% CI: $836 to $1248), while EO costs were $32 (95% CI: $25 to $39), resulting in a net incremental cost of $996 per enrolee (95% CI: $806 to $1,217). The ICERs were $68,658/QALY based on EQ-5D (95% CI: -$463,535 to $596,661) and $49,284/QALY based on SF-6D (95% CI: $26,971 to $159,309). Estimates of treatment costs in a real-world setting were accompanied by substantially lower ICERs that are within accepted thresholds for willingness-to-pay. Discussion: Although the intervention had short-term benefits sufficient to yield acceptable ICERs, there was no long-term effect of PST over EO observed in the study. Consequently, we suggest that future studies examine the use of low-cost approaches, such as booster relapse-prevention calls, that may lead to a sustained treatment benefit for this population.

Original languageEnglish (US)
JournalJournal of Telemedicine and Telecare
DOIs
StateAccepted/In press - Jan 1 2017

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Brain Concussion
Telephone
Cost-Benefit Analysis
Costs and Cost Analysis
Education
Quality-Adjusted Life Years
Therapeutics
Military Personnel
Secondary Prevention
Health Care Costs
Delivery of Health Care
Population

Keywords

  • Cost effectiveness
  • cost minimization
  • telehealth

ASJC Scopus subject areas

  • Health Informatics

Cite this

Economic evaluation of telephone-based concussion management for combat-related mild traumatic brain injury. / Richardson, John S.; Guzauskas, Gregory F.; Fann, Jesse R.; Temkin, Nancy R.; Bush, Nigel E.; Bell, Kathleen R.; Gahm, Gregory A.; Smolenski, Derek J.; Brockway, Jo Ann; Hansen, Ryan N.

In: Journal of Telemedicine and Telecare, 01.01.2017.

Research output: Contribution to journalArticle

Richardson, John S. ; Guzauskas, Gregory F. ; Fann, Jesse R. ; Temkin, Nancy R. ; Bush, Nigel E. ; Bell, Kathleen R. ; Gahm, Gregory A. ; Smolenski, Derek J. ; Brockway, Jo Ann ; Hansen, Ryan N. / Economic evaluation of telephone-based concussion management for combat-related mild traumatic brain injury. In: Journal of Telemedicine and Telecare. 2017.
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abstract = "Introduction: Mild traumatic brain injury (mTBI) is an unfortunately common repercussion of military service in a combat zone. The CONTACT study tested an individualized telephone support intervention employing problem solving therapy (PST) for mTBI in soldiers recently returned from deployment. We sought to determine the cost effectiveness of this intervention from a military healthcare system perspective. Methods: We conducted an intent-to-treat post-hoc analysis by building a decision analytic model that evaluated the choice between using PST or education only (EO). The model included cost-minimization and cost-effectiveness analyses. The incremental cost-effectiveness ratios (ICERs) were calculated as the differences in costs of PST versus EO relative to the differences in the outcomes of participants. Results: The PST intervention resulted in an annual per-enrolee cost of $1027 (95{\%} CI: $836 to $1248), while EO costs were $32 (95{\%} CI: $25 to $39), resulting in a net incremental cost of $996 per enrolee (95{\%} CI: $806 to $1,217). The ICERs were $68,658/QALY based on EQ-5D (95{\%} CI: -$463,535 to $596,661) and $49,284/QALY based on SF-6D (95{\%} CI: $26,971 to $159,309). Estimates of treatment costs in a real-world setting were accompanied by substantially lower ICERs that are within accepted thresholds for willingness-to-pay. Discussion: Although the intervention had short-term benefits sufficient to yield acceptable ICERs, there was no long-term effect of PST over EO observed in the study. Consequently, we suggest that future studies examine the use of low-cost approaches, such as booster relapse-prevention calls, that may lead to a sustained treatment benefit for this population.",
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AU - Guzauskas, Gregory F.

AU - Fann, Jesse R.

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AU - Bush, Nigel E.

AU - Bell, Kathleen R.

AU - Gahm, Gregory A.

AU - Smolenski, Derek J.

AU - Brockway, Jo Ann

AU - Hansen, Ryan N.

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AB - Introduction: Mild traumatic brain injury (mTBI) is an unfortunately common repercussion of military service in a combat zone. The CONTACT study tested an individualized telephone support intervention employing problem solving therapy (PST) for mTBI in soldiers recently returned from deployment. We sought to determine the cost effectiveness of this intervention from a military healthcare system perspective. Methods: We conducted an intent-to-treat post-hoc analysis by building a decision analytic model that evaluated the choice between using PST or education only (EO). The model included cost-minimization and cost-effectiveness analyses. The incremental cost-effectiveness ratios (ICERs) were calculated as the differences in costs of PST versus EO relative to the differences in the outcomes of participants. Results: The PST intervention resulted in an annual per-enrolee cost of $1027 (95% CI: $836 to $1248), while EO costs were $32 (95% CI: $25 to $39), resulting in a net incremental cost of $996 per enrolee (95% CI: $806 to $1,217). The ICERs were $68,658/QALY based on EQ-5D (95% CI: -$463,535 to $596,661) and $49,284/QALY based on SF-6D (95% CI: $26,971 to $159,309). Estimates of treatment costs in a real-world setting were accompanied by substantially lower ICERs that are within accepted thresholds for willingness-to-pay. Discussion: Although the intervention had short-term benefits sufficient to yield acceptable ICERs, there was no long-term effect of PST over EO observed in the study. Consequently, we suggest that future studies examine the use of low-cost approaches, such as booster relapse-prevention calls, that may lead to a sustained treatment benefit for this population.

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