Assessing the Impact of Telemedicine Interventions on Health Care Costs and Utilization: A Scoping Review (Preprint)

Abstract

BACKGROUND The utilization of telemedicine has increased notably since the onset of the pandemic. Understanding the influence of telemedicine on health care costs and utilization can contribute to the monitoring and evaluation of telemedicine programs. OBJECTIVE This scoping review aimed to document the potential impact of telemedicine on health care costs and utilization across diverse health care contexts and to offer a summary of the statistical methodological approaches employed in assessing the impact of telemedicine on health care costs and utilization. METHODS A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews guidelines, spanning the last 10 years across 3 electronic databases: PubMed/Medline, Web of Science, and Scopus. The search strategy was in accordance with the PICO criteria; patients were defined as the target population; telehealth or telemedicine was defined as the intervention; and standard care or before-and-after self-comparison was defined as the comparison, with health care costs and utilization as the outcome measures. Additionally, the six different structural layers of the TOAST framework for telehealth services were utilized to characterize the interventions. The findings were synthesized and are presented in tables and figures for clarity. RESULTS Out of a total of 4,454 identified articles, 14 were selected for review, with approximately 36% (n=5) focusing on chronic conditions. The delivery modalities included telephone call, videoconference, web portal, and smartphone applications, mainly spanning teleconsultation, telemonitoring, and teletherapy with clinicians and nursing support or health care team involvement. Approximately 86% of the studies employed standard face-to-face clinical visits for the control group. Six out of the 12 studies evaluating health care costs and four out of the seven studies assessing health care utilization revealed statistically significant improvements in telehealth compared to the control group. In addition, approximately 43% of the studies conducted univariate and multivariable analyses, with half of the studies incorporating adjusted analyses to control for confounding variables. CONCLUSIONS Our scoping review suggested that, in the treatment phase, compared with standard face-to-face clinical visits, telemedicine has the potential to decrease health care costs and optimally utilize health resources. Additionally, a regression model was the most commonly used statistical approach for assessing the impact of telemedicine.