Cost-effectiveness analysis of telemedicine

Crowe, Bernard L.

doi:10.1258/1357633981931867

Cited by 32 publications

(26 citation statements)

References 6 publications

(8 reference statements)

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“…Some experiences showed that, if usability issues are not well addressed, even well-motivated patients may not use such systems in their routine self-monitoring. 25 Finally, the use of computerized systems may have an economic impact, for example, by increasing personnel costs, 26 due to the necessity of providing users with assistance in case of system breakdowns or for simple help requests. On the other hand, IT solutions, and in particular telecommunication systems, may reduce the number of periodical control visits in comparison to normal clinical practice, and in some situations may avoid hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of the Effect of the Use of Computer-Based Systems on the Metabolic Control of Patients with Diabetes Mellitus

Montani

Bellazzi

d’Annunzio

2001

Diabetes Technology & Therapeutics

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The purpose of this study was to evaluate, through a meta-analysis study, whether the use of computer-based systems reported in the literature improves the metabolic control of diabetic patients. On the retrieved papers, a set of meta-analysis studies were performed: first the difference of HbA1c between cases and controls at follow-up was evaluated (sign test); then the difference between cases and controls in the total variation of HbA1c from the beginning to the end of the trial was considered (method of effect sizes). The latter methodology was reapplied also on three more homogeneous article subgroups. The sign test was performed on 16 papers: in two of them, the HbA1c level was higher in the intervention group than in the control group at follow-up: it is unlikely that this is a random occurrence (p < 0.01). The method of effect sizes was first applied to 13 papers, as in the others some needed data were missing: the results obtained showed a statistically significant amelioration of metabolic control in the intervention group in comparison to the control group (p < 0.01). A progressive reinforcement of this outcome was obtained on the trial subgroups. Our study supports the hypothesis that the use of computer-based systems can be an effective means of improving metabolic control. The differential benefit obtained in the amelioration of HbA1c does not justify, by itself, the applicability of such systems into clinical practice; additional investigations should be carried out to evaluate the enhancement of other clinical and organizational indicators.

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Section: Discussionmentioning

confidence: 99%

Meta-Analysis of the Effect of the Use of Computer-Based Systems on the Metabolic Control of Patients with Diabetes Mellitus

Montani

Bellazzi

d’Annunzio

2001

Diabetes Technology & Therapeutics

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“…14,22 The CEA for the TelemedicineIslands project was done by Bracale et al, 30 rural telemedicine collaborative care intervention for depression by Pyne et al, 14 cognitive behavioral therapy for bulimia nervosa by Crow et al, 15 and telemedicine services for the delivery of outpatient pulmonary care for a rural population by Agha et al 22 Many articles are reviews of cost-effectiveness studies of telemedicine systems and the importance of performing a good analysis. [32][33][34][35][36][37][38] All reviews are from 1998 to 2002.…”

Section: Review Of Cost-utility and Cost-effectiveness Studiesmentioning

confidence: 99%

Cost-Utility and Cost-Effectiveness Studies of Telemedicine, Electronic, and Mobile Health Systems in the Literature: A Systematic Review

Díez

López-Coronado

Vaca

et al. 2015

Telemedicine and e-Health

404

281

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There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures.

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“…[25][26][27] We calculated costs for ATSM only, as there were no additional costs associated with usual care (ATSM was an adjunct to this care), and because use of health care services did not differ between the 2 groups. Intervention costs included nurse care manager training; development of ATSM messages; translation and recording of messages in 3 languages; programming setup costs for ATSM; patient recruitment and follow-up time; fi xed monthly ATSM maintenance; costs associated with outgoing weekly ATSM calls; and direct nurse telephone care management with patients.…”

Section: Cost Measurementsmentioning

confidence: 99%

Cost-Effectiveness of Automated Telephone Self-Management Support With Nurse Care Management Among Patients With Diabetes

Handley¹,

Shumway²,

Schillinger³

2008

The Annals of Family Medicine

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PURPOSE This study evaluated the cost-effectiveness of an automated telephone self-management support with nurse care management (ATSM) intervention for patients with type 2 diabetes, which was tested among patients receiving primary care in publicly funded (safety net) clinics, focusing on non-English speakers. METHODSWe performed cost analyses in the context of a randomized trial among primary care patients comparing the effects of ATSM (n = 112) and usual care (n = 114) on diabetes-related outcomes in 4 San Francisco safety net clinics. ATSM uses interactive phone technology to provide surveillance, patient education, and one-on-one counseling, and was implemented in 3 languages for a 9-month period. Cost utility was examined using quality-adjusted life-years (QALYs) derived from changes in scores on the 12-Item Short Form Health Survey. We also examined cost-effectiveness for costs associated with a 10% increase in the proportion of patients meeting diabetes-specifi c public health goals for increasing exercise, as recommended by Healthy People 2010 and the American Diabetes Association. RESULTSThe annual cost of the ATSM intervention per QALY gained, relative to usual care, was $65,167 for start-up and ongoing implementation costs combined, and $32,333 for ongoing implementation costs alone. In sensitivity analyses, costs per QALY ranged from $29,402 to $72,407. The per-patient cost to achieve a 10% increase in the proportion of intervention patients meeting American Diabetes Association exercise guidelines was estimated to be $558 when all costs were considered and $277 when only ongoing costs were considered.CONCLUSIONS The ATSM intervention for diverse patients with diabetes had a cost utility for functional outcomes similar to that of many other accepted interventions targeted at diabetes prevention and treatment, and achieved public health physical activity objectives at modest costs. Because a considerable proportion of costs were fi xed, cost-utility and cost-effectiveness estimates would likely be substantially improved in a scaled-up ATSM program. INTRODUCTIONI n the United States, costs associated with chronic illness care account for nearly 75% of medical expenditures.1 Type 2 diabetes, which affects more than 20 million individuals in this country alone, is associated with substantial morbidity and cost. Although organ damage related to diabetes is well recognized, diabetes also causes functional decline, depression, pain, and lost productivity.2-5 The estimated direct and indirect societal and health system costs attributable to diabetes totaled approximately $132 billion in 2002, with costs expected to rise to $156 billion by 2010. [6][7][8] In recent reviews of the cost-effectiveness of interventions for prevent- COS T-EF F EC T IV ENES S O F AT S M F OR DIA BE T E Sing or treating diabetes in developed countries, the majority of studies focus either on screening for diabetes or on treatment to avert complications, emphasizing medication-sensitive outcomes with long-term benefi ts....

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Cost-effectiveness analysis of telemedicine

Cited by 32 publications

References 6 publications

Meta-Analysis of the Effect of the Use of Computer-Based Systems on the Metabolic Control of Patients with Diabetes Mellitus

Meta-Analysis of the Effect of the Use of Computer-Based Systems on the Metabolic Control of Patients with Diabetes Mellitus

Cost-Utility and Cost-Effectiveness Studies of Telemedicine, Electronic, and Mobile Health Systems in the Literature: A Systematic Review

Cost-Effectiveness of Automated Telephone Self-Management Support With Nurse Care Management Among Patients With Diabetes

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