title: Assessment of the cost-effectiveness and clinical outcomes of a fourth-generation synchronous telehealth program for the management of chronic cardiovascular disease.
abstract: BACKGROUND
  Telehealth programs are a growing field in the care of patients. The evolution of information technology has resulted in telehealth becoming a fourth-generation synchronous program. However, long-term outcomes and cost-effectiveness analysis of fourth-generation telehealth programs have not been reported in patients with chronic cardiovascular diseases.
  
  
  OBJECTIVE
  We conducted this study to assess the clinical outcomes and cost-effectiveness of a fourth-generation synchronous telehealth program for patients with chronic cardiovascular diseases.
  
  
  METHODS
  We retrospectively analyzed 575 patients who had joined a telehealth program and compared them with 1178 patients matched for sex, age, and Charlson comorbidity index. The program included: (1) instant transmission of biometric data, (2) daily telephone interview, and (3) continuous decision-making support. Data on hospitalization, emergency department (ED) visits, and medical costs were collected from the hospital's database and were adjusted to the follow-up months.
  
  
  RESULTS
  The mean age was 64.5 years (SD 16.0). The mean number of monthly ED visits (mean 0.06 SD 0.13 vs mean 0.09 SD 0.23, P<.001), hospitalizations (mean 0.05 SD 0.12 vs mean 0.11 SD 0.21, P<.001), length of hospitalization (mean 0.77 days SD 2.78 vs mean 1.4 SD 3.6, P<.001), and intensive care unit admissions (mean 0.01 SD 0.07 vs mean 0.036 SD 0.14, P<.001) were lower in the telehealth group. The monthly mean costs of ED visits (mean US$20.90 SD 66.60 vs mean US$37.30 SD 126.20, P<.001), hospitalizations (mean US$386.30 SD 1424.30 vs mean US$878.20 SD 2697.20, P<.001), and all medical costs (mean US$587.60 SD 1497.80 vs mean US$1163.60 SD 3036.60, P<.001) were lower in the telehealth group. The intervention costs per patient were US$224.80 per month. Multivariate analyses revealed that age, telehealth care, and Charlson index were the independent factors for ED visits, hospitalizations, and length of hospitalization. A bootstrap method revealed the dominant cost-effectiveness of telehealth care over usual care.
  
  
  CONCLUSIONS
  Better cost-effectiveness and clinical outcomes were noted with the use of a fourth-generation synchronous telehealth program in patients with chronic cardiovascular diseases. The intervention costs of this new generation of telehealth program do not increase the total costs for patient care.
authors.affiliation: Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yi-Lwun
authors.initials: YL
authors.lastname: Ho
authors.forename: Jiun-Yu
authors.initials: JY
authors.lastname: Yu
authors.forename: Yen-Hung
authors.initials: YH
authors.lastname: Lin
authors.forename: Ying-Hsien
authors.initials: YH
authors.lastname: Chen
authors.forename: Ching-Chang
authors.initials: CC
authors.lastname: Huang
authors.forename: Tse-Pin
authors.initials: TP
authors.lastname: Hsu
authors.forename: Pao-Yu
authors.initials: PY
authors.lastname: Chuang
authors.forename: Chi-Sheng
authors.initials: CS
authors.lastname: Hung
authors.forename: Ming-Fong
authors.initials: MF
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics / Q000628:therapy*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017216:Telemedicine / Q000191:economics* / Q000379:methods
keywords: cardiovascular disease; cost-benefit analysis; telehealth