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.
The impact of home telehealth for stroke care on the health care system is uncertain. We found very limited information on intervention-related changes in service use, and no direct calculations of costs.
The evidence available indicates that home telehealth has no effect on hospitalization rates. It may have the potential to reduce primary care use. One study showed a significant reduction in patients’ office visits, presumably because the remote monitoring intervention offered an alternate avenue for communication. Changes in use of emergency or specialist services were not reported in any of the studies retrieved by our original search, which covered the years 2005-2010. A recent study reported that time to emergency care decreased with implementation of an intensive home monitoring system (Kuo et al., 2012).
Further research into the effects of home telehealth on the health care system is needed.
Emergency Services Use
No information on emergency services use was found in the studies retrieved in our initial search.
Recent Developments: A scan of material from 2011-2012, a time period not covered by our initial searches, found 1 article that addressed emergency services use (Kuo et al., 2012). In this study, an intensive home monitoring program for stroke patients appeared to decrease average time to accessing emergency care. This study’s pre-/post-test design was a limitation. As this study was not subject to the same level of analysis as the other studies included in this review, we will not attempt further analysis. See Kuo et al. (2012) for more details.
Summary: There is no evidence that home telehealth affects likelihood of hospitalization or re-hospitalization. However, only 1 study measured this outcome.
Study Details: Hospital admissions at follow-up were recorded in one Level 2 study (Salvador et al., 2008), which found no significant differences between the telehealth and usual care groups.
Primary Care Use
Summary: Primary care use was recorded in only 1 study. An association was found between use of home telehealth and significantly reduced contacts between patient and provider.
Study Details: Salvador et al. (2008) was the only study to report on primary care use. The authors found a statistically significant difference at follow up in the number of OAT-related consultations between patients and their provider (1.7 ±2.7 in intervention group vs. 13.8±4.9 in control group).
Specialist care use
No studies reported on specialist care use.
Telehealth Costs and Cost Comparisons
No studies reported on telehealth costs or cost comparisons.
 . As this study was retrieved in a final scan of 2011-2012 literature and was 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 its authors. See Kuo et al. (2012) for more details.