An Overview of Cost-Effectiveness of Telehealth Interventions for Chronic Heart Failure Patients
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Abstract
Background: Randomized controlled trials have shown that Telehealth interventions encompassed in Chronic Disease Management can reduce hospitalizations for Chronic Heart Failure patients. Less is known about the cost-effectiveness of these interventions. Policy makers and insurers around the world are looking for proof that Telehealth is a viable alternative to usual care. We are keen on assessing the existence, and quality, of the economic evidence from the scientific literature.
Objective: To provide an overview of the economic analysis of Telehealth interventions for Chronic Heart Failure patients from the scientific literature. Also, to address methodology of performed economic analyses and provide criticism.
Methods: Thirty two studies were included in this review. Data was extracted and economic quality was assessed by two independent researchers. Each paper was checked with the risk of bias tool and the methodological quality tool. Disputes were solved through mediation.
Results: Studies were mainly RCTs, carried out in the USA and on average 6 months in duration. Fifteen studies described a telephone case management, seven a combination of telephone case management and telemonitoring and another seven described only a telemonitoring intervention. Three more described video visits alone or in combination with telephone or in-person contact. Most studies collected information on the following outcomes: admission rate/hospitalization, quality of life and intervention costs. Nineteen studies reported cost savings with the deployment of Telehealth technologies, nine studies reported same costs and four studies reported incurred costs. However the interventions, costs, and outcomes were quite diverse and not comparable.
Conclusions: Results show that Telehealth interventions reduce cost of Chronic Disease Management for Chronic Heart Failure patients (almost 60% of interventions were cost saving). However a full economic analysis is scarce in scientific literature (cost-consequence analysis is predominant). Without proper economic analysis the cost-effectiveness of Telehealth in CHF remains unknown. This fact impairs adoption of Telehealth services.
Keywords: Review, Cost-effectiveness, Chronic Heart Failure, Telehealth, Telemedicine, Telecare, Telemonitoring.
Objective: To provide an overview of the economic analysis of Telehealth interventions for Chronic Heart Failure patients from the scientific literature. Also, to address methodology of performed economic analyses and provide criticism.
Methods: Thirty two studies were included in this review. Data was extracted and economic quality was assessed by two independent researchers. Each paper was checked with the risk of bias tool and the methodological quality tool. Disputes were solved through mediation.
Results: Studies were mainly RCTs, carried out in the USA and on average 6 months in duration. Fifteen studies described a telephone case management, seven a combination of telephone case management and telemonitoring and another seven described only a telemonitoring intervention. Three more described video visits alone or in combination with telephone or in-person contact. Most studies collected information on the following outcomes: admission rate/hospitalization, quality of life and intervention costs. Nineteen studies reported cost savings with the deployment of Telehealth technologies, nine studies reported same costs and four studies reported incurred costs. However the interventions, costs, and outcomes were quite diverse and not comparable.
Conclusions: Results show that Telehealth interventions reduce cost of Chronic Disease Management for Chronic Heart Failure patients (almost 60% of interventions were cost saving). However a full economic analysis is scarce in scientific literature (cost-consequence analysis is predominant). Without proper economic analysis the cost-effectiveness of Telehealth in CHF remains unknown. This fact impairs adoption of Telehealth services.
Keywords: Review, Cost-effectiveness, Chronic Heart Failure, Telehealth, Telemedicine, Telecare, Telemonitoring.
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