title: Cost comparison between home telemonitoring and usual care of older adults: a randomized trial (Tele-ERA).
abstract: BACKGROUND
  From 1992 to 2008, older adults in the United States incurred more healthcare expense per capita than any other age group. Home telemonitoring has emerged as a potential solution to reduce these costs, but evidence is mixed. The primary aim of the study was to evaluate whether the mean difference in total direct medical cost consequence between older adults receiving additional home telemonitoring care (TELE) (n=102) and those receiving usual medical care (UC) (n=103) were significant. Inpatient, outpatient, emergency department, decedents, survivors, and 30-day readmission costs were evaluated as secondary aim.
  
  
  METHODS
  Multivariate generalized linear models (GLMs) and parametric bootstrapping method were used to model cost and to determine significance of the cost differences. We also compared the differences in arithmetic mean costs.
  
  
  RESULTS
  From the conditional GLMs, the estimated mean cost differences (TELE versus UC) for total, inpatient, outpatient, and ED were -$9,537 (p=0.068), -$8,482 (p =0.098), -$1,160 (p=0.177), and $106 (p=0.619), respectively. Mean postenrollment cost was 11% lower than the prior year for TELE versus 22% higher for UC. The ratio of mean cost for decedents to survivors was 2.1:1 (TELE) versus 12.7:1 (UC).
  
  
  CONCLUSIONS
  There were no significant differences in the mean total cost between the two treatment groups. The TELE group had less variability in cost of care, lower decedents to survivors cost ratio, and lower total 30-day readmission cost than the UC group.
authors.affiliation: 1 Regenstrief Center for Healthcare Engineering, Purdue University , West Lafayette, Indiana.
authors.forename: Benjavan
authors.initials: B
authors.lastname: Upatising
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Wood
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kremers
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Christ
authors.forename: Yuehwern
authors.initials: Y
authors.lastname: Yih
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Hanson
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D010359:Patient Readmission / Q000706:statistics & numerical data; D017216:Telemedicine / Q000191:economics; D013686:Telemetry / Q000191:economics* / Q000379:methods*; D014481:United States
keywords: 30-day readmission; cost comparison; home telemonitoring; older adult; telemedicine