OBJECTIVES: Telehealth has proven effective with many disorders, but there is a paucity of data on the cost-effectiveness of telehealth on individuals 18 and over with co-occurring mental health and substance use disorders. This analysis was designed to build a decision analytic model to evaluate medical interventions using telehealth and in-person care or just in-person care to treat adults 18 and over with these conditions.

METHODS: We tracked the progression of depression, substance use disorder, and cumulative death among adults 18 and over using a Markov model with 50 annual cycles through three health states. Deterministic and probabilistic sensitivity analysis addressed uncertainly in estimating the parameters and around the model's assumptions.

RESULTS: A medical and behavioral health system that integrates telehealth and in-person care are cost-effective at a willingness to pay $50,000 per Quality Adjusted Life Year (QALY) compared with in-person care only. The incremental cost was $13,685, and the incremental effectiveness was a 27.7 QALY with an incremental cost-effectiveness ratio of $2,341 per QALY.

CONCLUSIONS: Appropriate referrals to integrated mental and substance use services using a hybrid approach of telehealth and in-person care is beneficial in reversing losses in quality of life and death.