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A Cost-Utility Analysis of LISTEN: Low-Intensity Mental Health Support via Telehealth-Enabled Network for Diabetes
Joahna Kevin Perez1, Mary Lou Chatterton2, Harish Raj Narandaran3
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Objectives:
This study assessed the cost-effectiveness of Low-Intensity mental health Support via a Telehealth Enabled Network (LISTEN) for adults experiencing diabetes distress, facilitated by diabetes health professionals.
Methods:
A within-trial cost-utility analysis included 428 participants randomized to either LISTEN (diabetes-specific problem-solving therapy) or usual care (web-based diabetes distress and generic mental health resources). Quality-adjusted life-years (QALYs) were derived using the Assessment of Quality of Life-4D. Costs were measured from health sector and societal perspectives using a self-reported resource use questionnaire. Incremental cost-effectiveness ratios were calculated and nonparametric bootstrapping estimated 95% confidence intervals. Costs were presented in Australian dollars (A$) for the 2021-2022 financial year.
Results:
The mean direct cost of delivering LISTEN was A$262 per person. Over 6 months, the LISTEN group had higher total QALYs (0.024; 95% confidence intervals [CI] 0.007 to 0.041). Compared with usual care, mean health sector cost (-A$3271; 95% CI -A$5134 to A$1008) and societal cost (-A$3588; 95% CI -A$5913 to A$860) were lower, although these differences were not statistically significant. At a A$50 000 per QALY willingness-to-pay threshold, LISTEN was dominant with a 94% probability of being cost-effective from both perspectives. Findings should be interpreted cautiously given the substantial missing data.
Conclusion:
LISTEN significantly improves health-related quality of life of adults with diabetes distress and is likely to be cost-effective. Point estimates show lower mean costs alongside QALY gains, but cost differences were not statistically significant.
