TY - JOUR
AU - E. S. Wong
AU - C. N. Dorsey
AU - T. C. Beatty
AU - J. F. Bobb
AU - K. Stefanik-Guizlo
AU - D. L. Key
AU - A. Ramaprasan
AU - A. E. Idu
AU - J. C. Fortney
AU - J. Mogk
AU - L. Palazzo
AU - R. M. Caldeiro
AU - D. King
AU - A. G. McWethy
AU - J. E. Glass
A1 - 
AB - Evidence-based digital therapeutics are a promising approach for the scale-up of substance use disorder (SUD) treatments. Despite demonstrated efficacy, utilization of digital therapeutics is low. Strategic implementation approaches have potential for increasing digital therapeutic use. Applicability to health systems depends, in part, on the economic costs. The objective of this study was to describe implementation and intervention costs of implementation strategies to increase uptake of an evidence-based digital treatment for SUD. We conducted an economic evaluation alongside a hybrid type III cluster-randomized trial within a large integrated health system. All clinics implemented a standard implementation (SI) strategy, and clinics were assigned using 2x2 factorial randomization to additionally receive practice facilitation (PF) and/or health coaching (HC). Implementation costs included the cost of time devoted to implementation activities and direct operating costs. Time devoted to implementation activities was ascertained through structured meeting logs and time use surveys. Operating costs were captured using project budget reports. Intervention costs included expenses for prescriptions and healthcare encounters related to the digital therapeutic, measured using electronic health record data. Univariate statistics were calculated for cost estimates with comparisons presented by trial arm, implementation activity, staff role and study month. Analyses were conducted from a health system perspective. Twenty-one primary care sites participated in the trial. Over the 50-month study period, the total cost of all implementation activities was $748,088. Implementation costs per clinic were highest in the SI + PF + HC arm ($48,029), followed by SI + HC ($36,544), SI + PF ($30,665) and SI alone ($24,774). Intervention costs were highest in the SI + PF + HC arm ($18,051), followed by SI + PF ($11,492), SI + HC ($967) and SI alone ($1,879). Findings from this study can guide health systems by informing the economic investment required to employ implementation strategies demonstrated to increase uptake of evidence-based practices for behavioral health conditions. Trial Registration: NCT05160233.
AD - Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America.; Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States of America.; Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America.; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, United States of America.
AN - 41505485
BT - PLOS Digit Health
C5 - Financing & Sustainability; Opioids & Substance Use; HIT & Telehealth
CP - 1
DA - Jan
DO - 10.1371/journal.pdig.0001145
DP - NLM
ET - 20260108
IS - 1
JF - PLOS Digit Health
LA - eng
N2 - Evidence-based digital therapeutics are a promising approach for the scale-up of substance use disorder (SUD) treatments. Despite demonstrated efficacy, utilization of digital therapeutics is low. Strategic implementation approaches have potential for increasing digital therapeutic use. Applicability to health systems depends, in part, on the economic costs. The objective of this study was to describe implementation and intervention costs of implementation strategies to increase uptake of an evidence-based digital treatment for SUD. We conducted an economic evaluation alongside a hybrid type III cluster-randomized trial within a large integrated health system. All clinics implemented a standard implementation (SI) strategy, and clinics were assigned using 2x2 factorial randomization to additionally receive practice facilitation (PF) and/or health coaching (HC). Implementation costs included the cost of time devoted to implementation activities and direct operating costs. Time devoted to implementation activities was ascertained through structured meeting logs and time use surveys. Operating costs were captured using project budget reports. Intervention costs included expenses for prescriptions and healthcare encounters related to the digital therapeutic, measured using electronic health record data. Univariate statistics were calculated for cost estimates with comparisons presented by trial arm, implementation activity, staff role and study month. Analyses were conducted from a health system perspective. Twenty-one primary care sites participated in the trial. Over the 50-month study period, the total cost of all implementation activities was $748,088. Implementation costs per clinic were highest in the SI + PF + HC arm ($48,029), followed by SI + HC ($36,544), SI + PF ($30,665) and SI alone ($24,774). Intervention costs were highest in the SI + PF + HC arm ($18,051), followed by SI + PF ($11,492), SI + HC ($967) and SI alone ($1,879). Findings from this study can guide health systems by informing the economic investment required to employ implementation strategies demonstrated to increase uptake of evidence-based practices for behavioral health conditions. Trial Registration: NCT05160233.
PY - 2026
SN - 2767-3170
SP - e0001145
ST - Economic cost of strategic implementation approaches to increase uptake of digital therapeutics for substance use disorders in a large integrated health system
T1 - Economic cost of strategic implementation approaches to increase uptake of digital therapeutics for substance use disorders in a large integrated health system
T2 - PLOS Digit Health
TI - Economic cost of strategic implementation approaches to increase uptake of digital therapeutics for substance use disorders in a large integrated health system
U1 - Financing & Sustainability; Opioids & Substance Use; HIT & Telehealth
U3 - 10.1371/journal.pdig.0001145
VL - 5
VO - 2767-3170
Y1 - 2026
ER -