The Need for Economic Evaluation of Telemedicine to Evolve: The Experience in Alberta, Canada

Abstract

Economic evaluation of telemedicine applications is required to provide decision makers in health care with appropriate information on costs and benefits of this information and communications technology. The level of economic evaluation should evolve as telemedicine applications mature. At the basic level, economic evaluation may include basic cost analysis and primarily observational data on nonmonetary benefits. The focus will change as telemedicine programs develop. At this intermediate level, practice patterns and workforce issues are addressed as they affect utilization and costs of telemedicine services. Longer-term economic evaluation, thus far not achieved in telemedicine assessment, should focus on assessment of health outcomes and economic impact. Alberta, Canada has made progress assessing telemedicine applications in psychiatry, radiology, rheumatology, and rehabilitation. Data availability and analytic resources continue to present challenges to economic assessment of telemedicine.

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“…For chronic and long-term disease management telehealth offers a broad range of potential tools that can enhance the health outcomes and effectiveness of the care delivery. Unfortunately, much of the evidence, is fragmented and based on limited proof-of-concept applications, lacking information on large-scale performance and economic impact on real scenarios [121], [568]. Assuming that all medical products need to be adopted by the heavily regulated healthcare market at one point in time [569], the lack of large-scale validation and performance information on that kind of scenarios could be a barrier for its adoption on the current clinical practice [121].…”

“…But measuring health outcomes, costs, and organizational and societal impact requires long-term and rigorous clinical trials. The data requirements and logistics for such longterm economic assessment are likely to be demanding [568]. The pyramid of evidence, represented in the Figure 78 is the gold standard for the assessment of clinical evidence.…”

“…It could even require a significant fixed costs in new personnel [573]. Another limitation in many works is the few number of published studies concerning the longer-term economic impact of telemedicine [568]. Most studies agree that telemedicine could lead to a reduced use of health services such as physician office visits, emergency department visits, number of hospitalizations, hospital readmissions, home visits, length of hospital stay, use of ambulance services, number of referrals, duration of consultations, number of laboratory tests, and avoided transfers/evacuations [382]- [385], [573].…”

“…Usually a telemedicine program evolves through a known number of stages [568]: a) Pilot or introductory phase, focus on demonstrate the feasibility of the system (limited numbers of patients); b) a routine telemedicine service and c) deploy of the telemedicine application across an entire health system or expanded network. Each of these stages in the life of a telemedicine program requires a specific assessment, in order to analyse its feasibility, but the kind of assessment changes as the application matures, including changes in the focus of evaluation and the sources of information [568].…”

“…Health economics theories and methodologies are widely used in the healthcare for the evaluation of new interventions (i.e. new drugs, devices or procedures) in order to evaluate them in terms of costs and benefits and provide policy makers and program administrators with enough information to make decisions, nevertheless, economic evaluations of telemedicine remain rare [568], [573]. Health gains must be valued monetarily, ideally through the assessment of the willingness to pay for health gains.…”