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Abstract

Objective:

This study aimed to compare the costs of two implementation models for the mobile health (mHealth) intervention FOCUS in community mental health settings. The external facilitation (EF) approach uses a hub-and-spoke model, in which a central specialist provides support to clinicians and clients at multiple agencies. With the internal facilitation (IF) approach, frontline clinical staff at each center are trained to serve as their organization’s local specialists.

Methods:

Financial and economic cost data were collected in the context of a hybrid type 3 effectiveness-implementation trial by using a mixed-methods, top-down expenditure analysis with microcosting approaches. The analysis compared the incremental costs of both models and the costs of successfully engaging clients (N=210) at 20 centers. Costs were characterized as start-up or recurrent (personnel, supplies, contracted services, and indirect costs).

Results:

The average annual financial cost per site was $23,517 for EF and $19,118 for IF. EF yielded more FOCUS users at each center, such that the average monthly financial costs were lower for EF ($167 per client [N=129]) than for IF ($177 per client [N=81]). When using a real-world scenario based on economic costs and a lower organizational indirect rate, the average monthly cost per client was $73 for EF and $59 for IF. Both models reflected substantial cost reductions (about 50%) relative to a previous deployment of FOCUS in a clinical trial.

Conclusions:

Compared with IF, EF yielded more clients who received mHealth at community mental health centers and had comparable or lower costs.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 357 - 362
PubMed: 37880968

History

Received: 20 March 2023
Revision received: 24 July 2023
Accepted: 1 September 2023
Published online: 26 October 2023
Published in print: April 01, 2024

Keywords

  1. mHealth
  2. Schizophrenia
  3. Implementation science
  4. Digital interventions
  5. Community mental health centers
  6. Cost-effectiveness analysis

Authors

Details

Carol E. Levin, Ph.D.
Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller).
Justin Tauscher, Ph.D.
Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller).
Suzanne Meller, M.P.H., M.S.W.
Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller).
Rachel M. Brian, M.P.H.
Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller).
Benjamin E. Buck, Ph.D.
Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller).
Dror Ben-Zeev, Ph.D. [email protected]
Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller).

Notes

Send correspondence to Dr. Ben-Zeev ([email protected]).

Funding Information

This project was supported by a grant (R01MH116057 to Dr. Ben-Zeev, principal investigator) and a career development award (K23MH122504 to Dr. Buck) from NIMH.

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