The economic effects of home telehealth can be discussed using direct or indirect measures of costs and cost savings. Direct measures include figures such as cost per patient, cost per telehealth unit, and annual costs. Examples of indirect measures are probability of patient hospitalization, number of emergency room visits, and other types of health service use. Though a formal economic analysis would typically assign these services a fixed dollar value, other study designs often report changes in service use without attempting to translate these changes into costs or cost savings.
Information on the costs of home telehealth for asthma management is in extremely short supply and of limited applicability within the context of the Canadian health care system. In a detailed economic analysis from the Netherlands, a home telehealth program did not save costs and was of limited cost-effectiveness. A search of the most recent literature found 2 additional economic analyses, suggesting that the amount of attention given to this aspect of home telehealth may be on the increase. A cost-effectiveness analysis from 2011 found no major differences between home telehealth and usual care, although findings were sensitive to small changes in parameters. A 2012 cost-savings analysis of an intervention using mobile phones found that usual care was more cost effective. As these studies were retrieved in a final scan of 2011-2012 literature and were not subject to the same level of analysis as the other studies included in this review, we will not attempt to extrapolate beyond the conclusions provided by their authors. See Ryan et al. (2012) and van der Meer et al. (2011) for more details.
Home telehealth does not appear to have a significant effect on likelihood of hospitalization. The limited evidence that exists suggests that it does not lead to significant changes in use of specialist care or primary care either. Its effects on use of emergency services also appear minimal; although our review found one instance in which unscheduled visits to an acute care clinic increased in the intervention group, these patients’ asthma control was actually better than that of patients under usual care. It is possible that the intervention removed barriers to seeking unscheduled care when appropriate.
At present, the evidence suggests that cost savings from home telehealth programs should not be expected. However, more research is needed before we can see whether the findings of the above studies are valid in other health care systems and with other forms of home telehealth.
Emergency Services Use
Summary: Three studies report on frequency of emergency services use. The effect of home telehealth on the use of emergency services appears minimal. Although we found one study in which unscheduled visits to an acute care clinic increased in the intervention group, these patients’ asthma control was actually better than that of patients under usual care. It is possible that the intervention removed barriers to seeking unscheduled care when appropriate.
Study Details: In Willems et al. (2007), 4 members of the control group and no members of the intervention group made emergency room visits over the course of the 12-month study. This difference was not statistically significant. Rasmussen et al. (2005), while not drawing any conclusions, note that 2 patients in the intervention group visited the emergency department during the 6-month study period. However, acute unscheduled visits to the study respiratory clinic were significantly higher in the intervention group. During the average month of the 6-month study, 3.7% of intervention patients made such visits vs. 2.1% of patients in Control Group 1 and 1.3% of those in Control Group 2. The intervention group’s higher rate of visits cannot be explained by poorer disease management; the intervention group had significantly greater improvements in symptom reduction and lung function than either of the control groups. It is possible that the intervention removed barriers to seeking unscheduled care when appropriate. Prabhakaran et al. (2010) found that 57 patients in the control group, or 95%, had a reduction in emergency room visits. This was the case for only 51 patients in the intervention group (85%). However, this difference was not significant.
Summary: Three studies provide information on (re-) hospitalizations. At present, there is no evidence that home telehealth has significant effect on the likelihood of hospitalization.
Study Details: In a 12-month study by Willems et al. (2008), no hospitalizations occurred in either the control or the intervention group. Rasmussen et al. (2005) reports only that 1 control group patient was hospitalized for an exacerbation. In Prabhakaran et al. (2010), a number of patients in both the intervention and the control groups were admitted to hospital over the course of the study. This may be attributable in part to the study’s eligibility criteria, which required a recent hospitalization for asthma exacerbation. However, there was no significant difference between groups.
Primary Care Use
Summary: Two studies report on primary care use. The limited evidence does not support an association between home telehealth and reductions in primary care use.
Study Details: Willems et al. (2008) found no significant difference between groups in medical consumption, including use of primary care. Rasmussen et al. (2005) found that the average month of the 6-month intervention saw 3.7% of intervention group patients making acute unscheduled visits to the study respiratory clinic – significantly higher than the percentage seen in Control Groups 1 and 2 (3.7% and 1.3% respectively). This finding is discussed in more detail in Emergency Services Use, above.
Specialist Care Use
Summary: Little information is available on the effects of home telehealth on specialist care use. There is currently no evidence of an intervention effect.
Study Details: Both secondary care use and total medical consumption were measured in Willems et al. (2007, 2008). There was no significant difference between intervention and control groups in either respect.
Telehealth Costs and Cost Comparisons
Summary: There is insufficient evidence on telehealth costs and cost comparisons.
Study Details: Only 1 study reports telehealth costs and cost comparisons. Researchers in Willems et al. (2007) attempt a complex economic analysis of the intervention. This study used cost diaries and hospital billing records to estimate resource use during the 12-month intervention. Approximate expenses were also calculated for productivity loss, school absenteeism, and telehealth equipment and personnel.
A brief selection of findings:
- Mean 1 year costs of the intervention were roughly €532 per patient.
- Mean health care costs over 1 year in the intervention group averaged €2,228 (SD €1,582) among adults and €1,193 (SD €582) among children. Costs were lower in the control group (€1,720 (SD €1,742) for adults; €588 (SD €850) for children).
- Costs of informal care averaged twice as much in the intervention group as in the control group (€127 (SD €323) vs. €62 (SD €214)).
- The intervention was slightly more cost-effective among adults that among children.
- Productivity losses were 5 times higher in the intervention group, though this is in part due to the fact that more intervention group patients were engaged in paid labour at the time of the study.
- The mean incremental cost-effectiveness ratio was €15,366/quality-adjusted life year gained from the perspective of the health care system and €31,035 /quality-adjusted life year from the societal perspective.
As this study was conducted in the Netherlands, its applicability to the Canadian health care system is limited. Those interested will find many additional details in Willems et al. (2007).
Recent Developments: A scan of material from 2011-2012, a time period not covered by our initial searches, found 1 additional article that addressed telehealth costs and cost savings (van der Meer et al., 2011). In this study, a cost-effectiveness analysis on an online monitoring program showed no major differences between home telehealth and usual care. The authors note that findings were sensitive to small changes in various parameters. They further note that program costs were calculated only for the first year of implementation, and were expected to decrease thereafter. See van der Meer et al. (2011) for more details.