Abstract
Background: In light of the limited accessibility of evidence-based treatments for substance use disorders (SUD), coupled with the excess health care costs associated with untreated SUD, digital health has the potential to be transformative in addressing substance use and related chronic co-occurring conditions. This research aimed to evaluate the economic impact of Pelago (PEL), an integrated digital intervention combining psychosocial and pharmacological treatment targeting alcohol, tobacco, and opioid use disorders in a commercially insured adult population (N = 7,586). The model provided telehealth services using a smartphone application, from which clinician-facilitated videoconferencing and asynchronous messaging were delivered, along with digital, evidence-based therapy content and pharmacotherapy. Methods: Using a longitudinal model, a return on investment (ROI) analysis was undertaken to evaluate the impact of PEL on all-cause medical plan utilization costs 12 months before and after treatment initiation, relative to a matched control group. Results: In the 12 months following PEL registration, the intent-to-treat cohort who received the digital intervention evidenced an average all-cause medical plan utilization cost savings of $6,758 or 33% less per participant (4.5 ROI; p = 0.001). Among 1,172 participants who received PEL, a total savings of $7,920,376, relative to total program costs of $1,747,452 yielded a 4.5:1 ROI. Conclusions: Evidence-based treatment for SUD delivered via telehealth is associated with a significant positive ROI. Employers and payers willing to offer access to digital SUD care can mitigate morbidity and mortality while concurrently reducing medical costs and service utilization.