Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial

Abstract

Objective To examine the costs and cost effectiveness of telehealth in addition to standard support and treatment, compared with standard support and treatment.Design Economic evaluation nested in a pragmatic, cluster randomised controlled trial.Setting Community based telehealth intervention in three local authority areas in England.Participants 3230 people with a long term condition (heart failure, chronic obstructive pulmonary disease, or diabetes) were recruited into the Whole Systems Demonstrator telehealth trial between May 2008 and December 2009. Of participants taking part in the Whole Systems Demonstrator telehealth questionnaire study examining acceptability, effectiveness, and cost effectiveness, 845 were randomised to telehealth and 728 to usual care.Interventions Intervention participants received a package of telehealth equipment and monitoring services for 12 months, in addition to the standard health and social care services available in their area. Controls received usual health and social care.Main outcome measure Primary outcome for the cost effectiveness analysis was incremental cost per quality adjusted life year (QALY) gained. ResultsWe undertook net benefit analyses of costs and outcomes for 965 patients (534 receiving telehealth; 431 usual care). The adjusted mean difference in QALY gain between groups at 12 months was 0.012. Total health and social care costs (including direct costs of the intervention) for the three months before 12 month interview were £1390 (€1610; $2150) and £1596 for the usual care and telehealth groups, respectively. Cost effectiveness acceptability curves were generated to examine decision uncertainty in the analysis surrounding the value of RESEARCHthe cost effectiveness threshold. The incremental cost per QALY of telehealth when added to usual care was £92 000. With this amount, the probability of cost effectiveness was low (11% at willingness to pay threshold of £30 000; >50% only if the threshold exceeded about £90 000). In sensitivity analyses, telehealth costs remained slightly (non-significantly) higher than usual care costs, even after assuming that equipment prices fell by 80% or telehealth services operated at maximum capacity. However, the most optimistic scenario (combining reduced equipment prices with maximum operating capacity) eliminated this group difference (cost effectiveness ratio £12 000 per QALY). ConclusionsThe QALY gain by patients using telehealth in addition to usual care was similar to that by patients receiving usual care only, and total costs associated with the telehealth intervention were higher. Telehealth does not seem to be a cost effective addition to standard support and treatment.Trial registration ISRCTN43002091.

Cost Comparison Between Home Telemonitoring and Usual Care of Older Adults: A Randomized Trial (Tele-ERA)

“…Although a recent study of telehealth for patients with long-term conditions (e.g., congestive heart failure [CHF], chronic obstructive pulmonary disease, or diabetes) indicated an insignificant total cost difference, the mean total cost of care at the 12-month follow-up was $360 lower (standardized difference of 11.6%) for telemonitoring care (n = 431) compared with usual care (n = 538) when the intervention cost was excluded and $308 (9.9%) higher when it was included. 2 In a home telecare study of CHF patients, the mean total costs of care (all causes) in the telecare group (mean [standard deviation (SD)]: $5,850 [$21,094], n = 13) and telephone care group ($7,320 [$24,440], n = 12) interventions trended lower but were not significantly different than those for usual care ($44,479 [$121,214], n = 12). However, the mean costs of CHF-related emergency department (ED) visits for both interventions were significantly lower than those for usual care (mean [ In patients with multimorbidity, we have even less evidence.…”

The emergence and unfolding of telemonitoring practices in different healthcare organizations

“…Great expectations of telemonitoring have resulted in extensive experimentation with various telemonitoring services around the world. However, positive results from pilot studies are difficult to replicate when implemented on a larger scale [4,6]. An explanation of the absence of effect can be found by focusing on the telemonitoring practices that emerge and unfold as telemonitoring is adopted, modified, or ignored in the mundane activities performed by the health professionals.…”

“…This belief has led to extensive experimentation with various forms of home telemonitoring services throughout the world (see [2]). Even though multiple pilot studies have shown promising results in regard to telemonitoring's cost-effectiveness and patient-related effects (e.g., [3]), recent results from large-scale studies indicate that these effects are difficult to replicate when implemented on a large scale as part of routine services [4][5][6]. As this study illustrates, an explanation of this diminished effectiveness in large-scale projects can be found by focusing on the emergence of telemonitoring practices and how these practices are (dis)connected to the existing practices of the various health professionals responsible for delivering the telemonitoring services.…”

Travel in Britain in 2035: Future scenarios and their implications for technology innovation

“…Technology Enabled Care Services that encompass telehealth, telecare, telemedicine, telecoaching and self-care apps with remote video consultation are starting to be used in rural countries such as Australia. 5 This technology is also developing in the UK, although current evidence for its effectiveness and cost effectiveness is mixed, and strong barriers to adoption remain (Greenhalgh et al 2012;Henderson et al 2013). Consumer preferences are likely to play an important role in their success.…”