title: Telemonitoring for chronic obstructive pulmonary disease: a cost and cost-utility analysis of a randomised controlled trial.
abstract: We compared the costs and cost-effectiveness of telemonitoring vs usual care for patients with chronic obstructive pulmonary disease (COPD). A total of 256 patients were randomised to either telemonitoring or usual care. In the telemonitoring arm, the touch-screen telemonitoring equipment transmitted data to clinical teams monitoring the patients. Total healthcare costs were estimated over a 12-month period from a National Health Service perspective and quality adjusted life year (QALYs) were estimated by the EQ-5D tool. Telemonitoring was not significantly more costly than usual care (mean difference per patient £2065.90 (P < 0.18). The increased costs were predominantly due to telemonitoring service costs and non-significantly higher secondary care costs. Telemonitoring for COPD was not cost-effective at a base case of £137,277 per QALY with only 15% probability of being cost-effective at the usual threshold of £30,000 per QALY. Although there was some statistical and methodological uncertainty in the measures used, telemonitoring was not cost-effective in the sensitivity analyses performed. It seems unlikely that a telemonitoring service of the kind that was trialled would be cost-effective in providing care for people with COPD.
authors.affiliation: Edinburgh Health Services Research Unit (HSRU), Centre for Population Health Sciences, University of Edinburgh Medical School, Teviot Place Edinburgh, UK andrew.stoddart@ed.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stoddart
authors.affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Marjon
authors.initials: M
authors.lastname: van der Pol
authors.affiliation: Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
authors.affiliation: School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Hanley
authors.affiliation: E-health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: McCloughan
authors.affiliation: E-health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Allison
authors.initials: A
authors.lastname: Todd
authors.affiliation: Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK.
authors.forename: Ashma
authors.initials: A
authors.lastname: Krishan
authors.affiliation: E-health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: McKinstry
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000191:economics; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics* / Q000592:standards; D006113:United Kingdom