The Cost-Effectiveness Study

Mental health diseases are a main contributor to both the global and national burden of disease, and it has been estimated that 25% of the total national disease burden in Denmark can be ascribed to mental health diseases (Vendsborg et al., 2015). Furthermore, mental health diseases constitute a substantial burden on society with high costs related to loss of income, expenses for social supports, and a range of indirect costs due to a chronic disability that begins early in life. In Denmark, the annual socioeconomic cost amounts to 55 billion Danish kroner, of which only 10% is related to direct health care treatment (Vendsborg et al., 2015).

The use of various telehealth care solutions for treatment of mental health diseases have been proposed and are believed to hold great potential for the individual patient as well as for society (Voss, 2009). Despite evidence showing that telehealth care can lead to significant health benefits for particular mental health diseases, the associated costs of providing telehealth care are less well established (Conn et al., 2015; Hilty et al., 2013).

To provide decision-makers with evidence on whether the resources currently being invested in this area represent an efficient use of scarce resources, the aim of the cost-effectiveness study is to determine whether the telehealth care interventions evaluated in the NoDep Blended Care Study and the mDiary Study are cost-effective compared to usual care. Additionally, the aim of the study is to establish if there are any common subgroups of patients with different mental health disorders for whom telehealth care might be cost-effective.

The economic evaluations for the NoDep Blended Care Study and the mDiary Study will be carried out as cost-utility analyses, where costs collected from both a societal and health care sector perspective and quality-adjusted life years (QALY) will be used as outcome measures. Health-related quality of life used in the calculation of QALY will be measured at baseline and after 3, 6, and 12 months follow-up using the EuroQol-5Dimensions-5Level (EQ-5D-5L) instrument. The analyses will be conducted as within-trial analyses with a 12-month time horizon consistent with the follow-up period of the clinical trials.

Treatment costs, medication costs, and labor market consequences will be included in the analyses. Patient-specific data on resource utilization and unit costs will be obtained from the Danish National Health Insurance Service Register, the Danish National Patient Register, and the Danish National Prescription Registry. Furthermore, data will be obtained from Trimbos iMTA Questionnaire on costs for psychiatric illnesses (TIC-P) filled in by the patients.

An incremental cost-effectiveness ratio (ICER) will be calculated to assess the cost-effectiveness of the telehealth care interventions. The ICER is calculated as the mean difference in costs between the intervention and the control group divided by the mean difference in QALYs. To assess if the results are sensitive to uncertainty in the included parameters, sensitivity analyses will be conducted.


Conn, D., Gajaria, A., & Madan, R. (2015). Telepsychiatry: effectiveness and feasibility. Smart Homecare Technology and TeleHealth, Volume 3, 59.

Vendsborg, P., Lindhart, A., Gram, T., & Bentzen, J. (2015). Tal til psyken - Fakta om psykisk sundhed og psykisk sygdom 2015. Psykiatrifonden, 42.

Voss, H. (2009). Telepsykiatri i Danmark - hvad ved vi fra udlandet? København.


Lars Ehlers

Sabrina Storgaard Sørensen
Research Assistant (i.s.f PhD student)

Cathrine Elgaard Jensen 
PhD, assistant professor


The ENTER program consists of five research projects that aim to:

  1. Develop novel technologies and forms of service delivery improving treatment outcomes for patients within a mental health care setting.
  2. Provide evidence for the clinical and cost effective benefits and possible risks of using technologies in mental health care services.
  3. Enable ENTER´s industry partners to market their products nationally and internationally based on the proven feasibility of the technologies.
  4. Disseminate research results directed at the patient organisations and policy makers in mental health care, and representatives of multiple bodies of clinical practice – pending clinical efficacy, successful implementation in the care and management of patients with mental disorders and mental health problems.
  5. Establish a fruitful, collaborative research environment for e-mental health research with a national networking organization to persist beyond the present project.


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