title: Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial.
abstract: OBJECTIVE
  To examine the costs and cost effectiveness of telehealth in addition to standard support and treatment, compared with standard support and treatment.
  
  
  METHODS
  Economic evaluation nested in a pragmatic, cluster randomised controlled trial.
  
  
  METHODS
  Community based telehealth intervention in three local authority areas in England.
  
  
  METHODS
  3230 people with a long term condition (heart failure, chronic obstructive pulmonary disease, or diabetes) were recruited into the Whole Systems Demonstrator telehealth trial between May 2008 and December 2009. Of participants taking part in the Whole Systems Demonstrator telehealth questionnaire study examining acceptability, effectiveness, and cost effectiveness, 845 were randomised to telehealth and 728 to usual care.
  
  
  METHODS
  Intervention participants received a package of telehealth equipment and monitoring services for 12 months, in addition to the standard health and social care services available in their area. Controls received usual health and social care.
  
  
  METHODS
  Primary outcome for the cost effectiveness analysis was incremental cost per quality adjusted life year (QALY) gained.
  
  
  RESULTS
  We undertook net benefit analyses of costs and outcomes for 965 patients (534 receiving telehealth; 431 usual care). The adjusted mean difference in QALY gain between groups at 12 months was 0.012. Total health and social care costs (including direct costs of the intervention) for the three months before 12 month interview were £1390 (€1610; $2150) and £1596 for the usual care and telehealth groups, respectively. Cost effectiveness acceptability curves were generated to examine decision uncertainty in the analysis surrounding the value of the cost effectiveness threshold. The incremental cost per QALY of telehealth when added to usual care was £92 000. With this amount, the probability of cost effectiveness was low (11% at willingness to pay threshold of £30 000; >50% only if the threshold exceeded about £90 000). In sensitivity analyses, telehealth costs remained slightly (non-significantly) higher than usual care costs, even after assuming that equipment prices fell by 80% or telehealth services operated at maximum capacity. However, the most optimistic scenario (combining reduced equipment prices with maximum operating capacity) eliminated this group difference (cost effectiveness ratio £12 000 per QALY).
  
  
  CONCLUSIONS
  The QALY gain by patients using telehealth in addition to usual care was similar to that by patients receiving usual care only, and total costs associated with the telehealth intervention were higher. Telehealth does not seem to be a cost effective addition to standard support and treatment.
  
  
  BACKGROUND
  ISRCTN43002091.
authors.affiliation: London School of Economics and Political Science, London WC2A 2AE, UK. C.Henderson@lse.ac.uk
authors.forename: Catherine
authors.initials: C
authors.lastname: Henderson
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: José-Luis
authors.initials: JL
authors.lastname: Fernández
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beecham
authors.forename: Shashivadan P
authors.initials: SP
authors.lastname: Hirani
authors.forename: Martin
authors.initials: M
authors.lastname: Cartwright
authors.forename: Lorna
authors.initials: L
authors.lastname: Rixon
authors.forename: Michelle
authors.initials: M
authors.lastname: Beynon
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.forename: Helen
authors.initials: H
authors.lastname: Doll
authors.forename: Ray
authors.initials: R
authors.lastname: Fitzpatrick
authors.forename: Adam
authors.initials: A
authors.lastname: Steventon
authors.forename: Martin
authors.initials: M
authors.lastname: Bardsley
authors.forename: Jane
authors.initials: J
authors.lastname: Hendy
authors.forename: Stanton P
authors.initials: SP
authors.lastname: Newman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000379:methods; D008297:Male; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics*