Behavioral activation for depression through telehealth may present an efficient and cost-effective alternative to in-person treatment, according to a study recently published in the Journal of Clinical Psychiatry.

Researchers working with a population of veterans found that the healthcare utilization costs of telehealth services were significantly cheaper compared with in-person visits, with only a relatively small difference in quality of life. Researchers claim that the study “offers important justification for increasing access to evidence-based depression treatment through new technologies” for older adults dealing with depression.

Participants were recruited from a southeastern Veterans Affairs Medical Center and its surrounding outpatient-based clinics, and were randomly assigned to receive 8-week behavioral activation therapy delivered either in-person or via telehealth. Medication stabilization was required, and patients were asked to maintain dosages when medically possible. Depression was measured using the Geriatric Depression Scale, Beck Depression Inventory, and Structured Clinical Interview for DSM-IV. Quality of life was measured using the 36-Item Short Form Health Survey.

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Intervention costs were measured according to estimated travel costs, technology costs, and wage loss associated with travel. The mean travel estimate was $258.56 per person for in-person visits and $0 for telehealth appointments. Technology costs ranged from $800 to $900 per person for telehealth accommodations and $0 for in-person visits. Wage losses were estimated to be $179.36 for in-person visits and $0 for telehealth appointments. Postintervention, Department of Veterans Affairs costs at 12 months for veterans receiving in-person treatment were $2998 higher than preintervention costs, and costs for veterans receiving telehealth services were $870.91 higher on average. Quality-adjusted life-years increased from baseline by a mean of 0.31 for in-person care and 0.13 for telehealth.

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The researchers noted that the study excluded those with substance dependence, suicidal concerns, and active psychosis, and that the population studied may be sicker and have more comorbidities than the general population. In addition, the device used in the study is now obsolete for clinical care; however, newer devices can easily deliver care and are likely to be cheaper and have better video quality.

These findings suggest that alternative and more cost-effective means of treatment may be possible for many adults struggling with depression.


Egede L E, Dismuke C E, Walker R J, et al. Cost-effectiveness of behavioral activation for depression in older adult veterans: in-person care versus telehealth. J Clin Psychiatry. 2018;79:5.