A Cost-Utility Analysis of LISTEN: Low-Intensity Mental Health Support via Telehealth-Enabled Network for Diabetes Distress

OBJECTIVES: This study assessed the cost-effectiveness of LISTEN (Low-Intensity mental health Support via a Telehealth Enabled Network) for adults experiencing diabetes distress, facilitated by diabetes health professionals. METHODS: A within-trial cost-utility analysis included 428 participants randomised 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 (AQoL-4D). Costs were measured from health sector and societal perspectives using a self-reported resource use questionnaire. Incremental cost-effectiveness ratios (ICERs) were calculated and non-parametric bootstrapping estimated 95% confidence intervals. Costs were presented in Australian dollars (A$) for the 2021-22 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% CI 0.007 to 0.041). Compared to usual care, mean health sector cost (-A$3,271; 95% CI -A$5,134 to A$1,008) and societal cost (-A$3,588; 95% CI -A$5,913 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.