title: Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial.
abstract: To investigate the cost-effectiveness of a telehealth intervention for primary care patients with raised cardiovascular disease (CVD) risk.
  
  
  
  A prospective within-trial patient-level economic evaluation conducted alongside a randomised controlled trial.
  
  
  
  Patients recruited through primary care, and intervention delivered via telehealth service.
  
  
  
  Adults with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, with at least 1 modifiable risk factor.
  
  
  
  A series of up to 13 scripted, theory-led telehealth encounters with healthcare advisors, who supported participants to make behaviour change, use online resources, optimise medication and improve adherence. Participants in the control arm received usual care.
  
  
  
  Cost-effectiveness measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Productivity impacts, participant out-of-pocket expenditure and the clinical outcome were presented in a cost-consequences framework.
  
  
  
  641 participants were randomised-325 to receive the telehealth intervention in addition to usual care and 316 to receive only usual care. 18% of participants had missing data on either costs, utilities or both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient National Health Service (NHS) costs of £138 (95% CI 66 to 211) and an incremental QALY gain of 0.012 (95% CI -0.001 to 0.026). The incremental cost-effectiveness ratio was £10 859. Net monetary benefit at a cost-effectiveness threshold of £20 000 per QALY was £116 (95% CI -58 to 291), and the probability that the intervention was cost-effective at this threshold value was 0.77. Similar results were obtained from a complete case analysis.
  
  
  
  There is evidence to suggest that the Healthlines telehealth intervention was likely to be cost-effective at a threshold of £20 000 per QALY.
  
  
  
  ISRCTN27508731; Results. Prospectively registered 05 July 2012.
authors: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: Padraig
authors: P
authors: Dixon
authors: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: Sandra
authors: 0000-0003-0782-3117
authors: S
authors: Hollinghurst
authors: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: Louisa
authors: L
authors: Edwards
authors: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: Clare
authors: C
authors: Thomas
authors: Bristol Randomised Trials Collaboration (BRTC), School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: Daisy
authors: D
authors: Gaunt
authors: Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors: Alexis
authors: A
authors: Foster
authors: Public Health England, Hampshire, UK.
authors: Shirley
authors: S
authors: Large
authors: Bristol Randomised Trials Collaboration (BRTC), School of Social and Community Medicine, University of Bristol, Bristol, UK Nottingham Clinical Trials Unit, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK.
authors: Alan A
authors: AA
authors: Montgomery
authors: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: Chris
authors: 0000-0002-4378-3960
authors: C
authors: Salisbury
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002318:Cardiovascular Diseases / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012044:Regression Analysis; D012307:Risk Factors; D057566:Self Report; D017216:Telemedicine / Q000191:economics*; D006113:United Kingdom
keywords: Angina; HEALTH ECONOMICS; STROKE MEDICINE