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 Were costs higher than benefits? A 3,000 patient study published in respected journal BMJ found hospital costs £188 lower and death rates probably reduced with telehealth monitoring. The costs were carefully not revealed, but the cost/benefit ratio clearly disappointed the research team.
Broadband “studies” often claim enormous financial benefits for telehealth. These typically are paid for by the carriers and used as arguments for large subsidies or other government favors. These “economists for hire” are often capable and articulate with strong academic credentials, although most of their work falls apart when closely examined. You can prove almost anything if allowed unsupportable assumptions, arbitrary choices of examples, or bad source data. This garbage flourishes because lazy reporters and policy advocates don’t check sources.
Thoughtful analysis in the paper made clear the study was far from definitive. The “usual care” control group saw a spike in hospital admissions in the first three months. It’s possible enrolling patients brought some issues to the attention of the GPs that called for treatment. In the balance of the study-year, there was apparently little difference in the costs. This work remains among the most substantial looks at telehealth benefits and the results positive.
Clare Horton in The Guardian writes “The estimated scale of hospital cost savings is modest and may not be sufficient to offset the cost of the technology.. She goes on to quote Adam Steventon, one of the researchers “Investment in telehealth is often justified on the basis that it will reduce hospital cost. However, in this trial, the reductions in hospital admissions translated into only modest reductions in costs. These differences were not statistically significant, so could have been the result of chance.”
My instinct is current telehealth methods are modestly valuable, although no more so than many other public health measures. More conscientious handwashing is the classic example. Simply ensuring that patients with cardiac risk take aspirin (many don’t) would have a high payoff. Better broadband networks are a good thing, but claim they are paid for with reduced medical costs is disingenuous.
The full study is Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial Here’s the abstract
Abstract
Objective To assess the effect of home based telehealth interventions on the use of secondary healthcare and mortality.
Design Pragmatic, multisite, cluster randomised trial comparing telehealth with usual care, using data from routine administrative datasets. General practice was the unit of randomisation. We allocated practices using a minimisation algorithm, and did analyses by intention to treat.
Setting 179 general practices in three areas in England.
Participants 3230 people with diabetes, chronic obstructive pulmonary disease, or heart failure recruited from practices between May 2008 and November 2009.
Interventions Telehealth involved remote exchange of data between patients and healthcare professionals as part of patients’ diagnosis and management. Usual care reflected the range of services available in the trial sites, excluding telehealth.
Main outcome measure Proportion of patients admitted to hospital during 12 month trial period.
Results Patient characteristics were similar at baseline. Compared with controls, the intervention group had a lower admission proportion within 12 month follow-up (odds ratio 0.82, 95% confidence interval 0.70 to 0.97, P=0.017). Mortality at 12 months was also lower for intervention patients than for controls (4.6% v 8.3%; odds ratio 0.54, 0.39 to 0.75, P<0.001). These differences in admissions and mortality remained significant after adjustment. The mean number of emergency admissions per head also differed between groups (crude rates, intervention 0.54v control 0.68); these changes were significant in unadjusted comparisons (incidence rate ratio 0.81, 0.65 to 1.00, P=0.046) and after adjusting for a predictive risk score, but not after adjusting for baseline characteristics. Length of hospital stay was shorter for intervention patients than for controls (mean bed days per head 4.87 v 5.68; geometric mean difference −0.64 days, −1.14 to −0.10, P=0.023, which remained significant after adjustment). Observed differences in other forms of hospital use, including notional costs, were not significant in general. Differences in emergency admissions were greatest at the beginning of the trial, during which we observed a particularly large increase for the control group.
Conclusions Telehealth is associated with lower mortality and emergency admission rates. The reasons for the short term increases in admissions for the control group are not clear, but the trial recruitment processes could have had an effect.
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