Evaluating the costs of developing a digital supervision tool for task-shared depression care: findings from a multi-site study in India

Abstract

BACKGROUND: Task-sharing with non-specialist providers offers a promising solution to the mental health workforce shortage in low-resource settings. Supervision is essential to ensure treatment quality, but is often constrained by limited specialist availability. AIMS: This study evaluated the costs of developing PEERS, a smartphone app that can facilitate registering and scheduling supervision sessions, collecting patient outcomes, rating therapy quality and assessing supervision quality among community-based non-specialist providers delivering behavioural activation for depression. METHOD: The PEERS digital application was developed between June 2021 and September 2022 for use in Madhya Pradesh and Goa, India. Development involved contributions from researchers, clinicians, technology experts and end users. Activity-based costing was used to systematically document the inputs and expenditures involved in developing the PEERS app and its accompanying training materials from a health systems perspective. Key cost components included human resources, leadership, IT support and infrastructure. RESULTS: Total development costs were US＄130 027, with the costs of information technology accounting for the largest share (81%; US＄105 110). Human resource contributions accounted for 17% (US＄22 523), which included oversight and contributions from international research collaborators. Additional costs included overhead and infrastructure (US＄2393). CONCLUSIONS: Digital tools are increasingly being used to expand access to and support the delivery of mental health interventions in low-resource settings, yet few studies report on the development costs. By estimating the costs and resources required for developing a digital app for peer supervision, this study can inform efforts to facilitate broader implementation and adaptation of the app for use in other settings.

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