PMID- 27798655
OWN - NLM
STAT- MEDLINE
DCOM- 20170619
LR  - 20191210
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 11
IP  - 10
DP  - 2016
TI  - Combining Time-Driven Activity-Based Costing with Clinical Outcome in 
      Cost-Effectiveness Analysis to Measure Value in Treatment of Depression.
PG  - e0165389
LID - 10.1371/journal.pone.0165389 [doi]
LID - e0165389
AB  - BACKGROUND: A major challenge of mental health care is to provide safe and 
      effective treatment with limited resources. The main purpose of this study was to 
      examine a value-based approach in clinical psychiatry when evaluating a process 
      improvement initiative. This was accomplished by using the relatively new time 
      driven activity based costing (TDABC) method within the more widely adopted 
      cost-effectiveness analysis framework for economic evaluation of healthcare 
      technologies. The objective was to evaluate the cost-effectiveness of allowing 
      psychologists to perform post-treatment assessment previously performed by 
      psychiatrists at an outpatient clinic treating depression using internet-based 
      cognitive-behavioral therapy (ICBT). METHODS: Data was collected from 568 adult 
      patients treated with ICBT for depression during 2013-2014. The TDABC methodology 
      was used to estimate total healthcare costs, including development of process 
      maps for the complete cycle of care and estimation of resource use and minute 
      costs of staff, hospital space and materials based on their relative proportions 
      used. Clinical outcomes were measured using the Patient Health Questionnaire 
      depression scale (PHQ-9) before and after treatment and at 6-month follow-up. 
      Cost-effectiveness analyses (CEA) was performed and the results presented as 
      incremental net benefits (INB), cost-effectiveness acceptability curves (CEACs) 
      and confidence ellipses to demonstrate uncertainty around the value of the 
      organizational intervention. OUTCOMES: Taking into account the complete 
      healthcare process (from referral to follow-up assessment), treatment costs 
      decreased from $709 (SD = $130) per patient in 2013 to $659 (SD = $134) in 2014 
      while treatment effectiveness was maintained; 27% had achieved full remission 
      from depression after treatment (PHQ-9 < 5) during both 2013 and 2014 and an 
      additional 35% and 33% had achieved partial remission in 2013 and 2014, 
      respectively. At follow-up, 42% were in full remission after treatment during 
      both 2013 and 2014; an additional 35% and 33% were in partial remission during 
      2013 and 2014, respectively. Confidence ellipses occupied the south-east (SE) and 
      south-west (SW) quadrants of the incremental cost-effectiveness plane at both 
      post-treatment and at follow-up, indicating that the ICBT treatment was less 
      costly and equally effective after staff reallocation. CONCLUSION: Treating 
      patients to the target of full remission using psychologists instead of medical 
      specialists for post-treatment assessment is cost-saving and consequently a more 
      valuable use of limited resources. TDABC may be a useful tool for measuring 
      resource costs, identifying quality improvement opportunities and evaluating the 
      consequences of such initiatives. Combining TDABC with clinical outcome measures 
      in CEA is potentially a useful approach in mental healthcare to estimate the 
      value of process improvement initiatives.
FAU - El Alaoui, Samir
AU  - El Alaoui S
AUID- ORCID: 0000-0002-6590-1606
AD  - Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska 
      Institutet, Stockholm, Sweden.
FAU - Lindefors, Nils
AU  - Lindefors N
AD  - Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska 
      Institutet, Stockholm, Sweden.
LA  - eng
PT  - Journal Article
DEP - 20161031
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adult
MH  - Confidence Intervals
MH  - *Cost-Benefit Analysis
MH  - Depression/*economics/*therapy
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Outcome Assessment, Health Care
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC5087942
COIS- The authors have declared that no competing interests exist.
EDAT- 2016/11/01 06:00
MHDA- 2017/06/20 06:00
PMCR- 2016/10/31
CRDT- 2016/11/01 06:00
PHST- 2016/02/21 00:00 [received]
PHST- 2016/10/11 00:00 [accepted]
PHST- 2016/11/01 06:00 [pubmed]
PHST- 2017/06/20 06:00 [medline]
PHST- 2016/11/01 06:00 [entrez]
PHST- 2016/10/31 00:00 [pmc-release]
AID - PONE-D-16-07475 [pii]
AID - 10.1371/journal.pone.0165389 [doi]
PST - epublish
SO  - PLoS One. 2016 Oct 31;11(10):e0165389. doi: 10.1371/journal.pone.0165389. 
      eCollection 2016.