Cost and cost-effectiveness of StepCare: A stepped mental health care service in Australian general practice. (Preprint)

BACKGROUND The online ‘StepCare’ Service identifies adults with common mental disorders, recommends evidence-based treatments and monitors symptoms and risk, with feedback to patient and GP. Proof of concept study data indicated that the Service is acceptable and feasible in general practice. OBJECTIVE As part of a larger implementation study of StepCare, we conducted an economic evaluation of the Service from multiple stakeholder perspectives. The economic evaluation included (1) a trial-based cost and cost effectiveness analysis and (2) a modelled cost-consequence analysis. An Australian public finance perspective was used, with costs disaggregated to give transparency to the investment contributed by the various stakeholders. METHODS General practices, GPs, practice staff and adult patients (18 years and over) in two large Australian Primary Health Networks (PHNs), one urban, the other rural/remote, were invited to take part in the full implementation study. For the trial-based analysis, an incremental cost-effectiveness ratio (ICER) was calculated based on one of two metrics identified as appropriate proxy measures for better alignment with stepped mental health care: GP diagnosis rate for anxiety and depression. The expected costs over a twelve-month period associated with usual practice compared to a fully implemented stepped care model were calculated in the modelled extrapolation. RESULTS The trial-based analyses calculated the incremental cost of implementing StepCare to be $54 per person screened, with a cost per newly diagnosed person of $10,750. The modelled evaluation calculated that over a 12 month period, the StepCare Service (screening and treatment) was associated with mean costs of $294 AUD per person compared to (i) usual care assuming no active screening and a quasi-stepped approach to treatment, costing a mean of $535 AUD per person and (ii) usual care assuming no active screening and treatment-as-usual (ie not quasi-stepped) costing a mean of $442 AUD per person. That is, StepCare was associated with lower costs than either of the two comparator scenarios. CONCLUSIONS Compared to current mental health care in general practice, StepCare is a cost-effective screening and patient management tool.