Systematic review of cost effectiveness studies of telemedicine interventions

doi:10.1136/bmj.324.7351.1434

BMJ 2002;324:1434-1437 ( 15 June )

Information in practice

Systematic review of cost effectiveness studies of telemedicine interventions

Pamela S Whitten, associate professor, ^a Frances S Mair, senior lecturer, ^b Alan Haycox, senior lecturer, ^c Carl R May, professor of medical sociology, ^d Tracy L Williams, research fellow, ^e Seth Hellmich, research assistant. ^a

^a Department of Telecommunications, Michigan State University, East Lansing, MI 48824-1212, USA, ^b Department of Primary Care, University of Liverpool, ^c Department of Pharmacology, University of Liverpool, ^d Centre for Health Services Research, University of Newcastle-upon-Tyne, ^e School of Primary Care, University of Manchester

Correspondence to: P S Whitten pwhitten{at}msu.edu

Objectives: To systematically review cost benefit studiesoftelemedicine.
Design: Systematic review of English language, peerreviewed journalarticles.
Data sources: Searches of Medline, Embase, ISI citationindexes, and database of Telemedicine InformationExchange.
Studies selected: 55 of 612 identified articles that presentedactual cost benefitdata.
Main outcome measures: Scientific quality of reports assessed byuse of an established instrument for adjudicating on the qualityof economicanalyses.
Results: 557 articles without cost data categorisedby topic. 55 articles with data initially categorised by costvariables employed in the study and conclusions. Only 24/55 (44%)studies met quality criteria justifying inclusion in a qualityreview. 20/24 (83%) restricted to simple cost comparisons. Nostudy used cost utility analysis, the conventional means of establishingthe "value for money" that a therapeutic intervention represents.Only 7/24 (29%) studies attempted to explore the level of utilisationthat would be needed for telemedicine services to compare favourablywith traditionally organised health care. None addressed thisquestion in sufficient detail to adequately answer it. 15/24 (62.5%)of articles reviewed here provided no details of sensitivity analysis,a method all economic analyses shouldincorporate.
Conclusion: There is no good evidence that telemedicineis a cost effective means of delivering healthcare.

What is already known on this topic
The use of telemedicine has garnered much attention in the past decade

Hundreds of articles have been published claiming that telemedicine is cost effective

However, missing from the literature is a synthesis or meta-analysis of these publications

What this study adds
A comprehensive literature search of cost related articles on telemedicine identified more than 600 articles, but only 9% contained any cost benefit data

Only 4% of these articles met quality criteria justifying inclusion in a formalised quality review, and most of these were small scale, short term, pragmatic evaluations with few generalisable conclusions

There is little published evidence to confirm whether or not telemedicine is a cost effective alternative to standard healthcare delivery

© BMJ 2002

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Articles

eHealth and the future: promise or peril?: Jeremy C Wyatt and Frank Sullivan
BMJ 2005 331: 1391-1393. [Extract] [Full Text] [PDF]

Email consultations in health care: Set your auto reply to "no": Geoff Wong
BMJ 2004 329: 1046. [Extract] [Full Text]

Systematic review of cost effectiveness in telemedicine: Paul Scuffham, A R Haycox, and F S Mair
BMJ 2002 325: 598. [Extract] [Full Text]

Telemedicine is not cost effective
BMJ 2002 324: 0. [Full Text]

This article has been cited by other articles:

Vitacca, M, Mazzu, M, Scalvini, S (2009). Socio-technical and organizational challenges to wider e-Health implementation. Chronic Respiratory Disease 6: 91-97 [Abstract]
Mort, M., Finch, T., May, C. (2009). Making and Unmaking Telepatients: Identity and Governance in New Health Technologies. Science Technology Human Values 34: 9-33 [Abstract]
Demaerschalk, B. M., Miley, M. L., Kiernan, T.-E. J., Bobrow, B. J., Corday, D. A., Wellik, K. E., Aguilar, M. I., Ingall, T. J., Dodick, D. W., Brazdys, K., Koch, T. C., Ward, M. P., Richemont, P. C., STARR Coinvestigators, (2009). Stroke Telemedicine. Mayo Clin Proc. 84: 53-64 [Abstract] [Full text]
MacLeod, K. J., Marcin, J. P., Boyle, C., Miyamoto, S., Dimand, R. J., Rogers, K. K. (2009). Using Telemedicine to Improve the Care Delivered to Sexually Abused Children in Rural, Underserved Hospitals. Pediatrics 123: 223-228 [Abstract] [Full text]
Mathews, K. A, Elcock, M. S, Furyk, J. S (2008). The use of telemedicine to aid in assessing patients prior to aeromedical retrieval to a tertiary referral centre. J Telemed Telecare 14: 309-314 [Abstract] [Full text]
Jackson, K. M., Scott, K. E., Graff Zivin, J., Bateman, D. A., Flynn, J. T., Keenan, J. D., Chiang, M. F. (2008). Cost-Utility Analysis of Telemedicine and Ophthalmoscopy for Retinopathy of Prematurity Management. Arch Ophthalmol 126: 493-499 [Abstract] [Full text]
Bukachi, F., Pakenham-Walsh, N. (2007). Information Technology for Health in Developing Countries. Chest 132: 1624-1630 [Abstract] [Full text]
Piette, J. D. (2007). Interactive Behavior Change Technology to Support Diabetes Self-Management: Where do we stand?. Diabetes Care 30: 2425-2432 [Full text]
Hanson, E., Magnusson, L., Arvidsson, H., Claesson, A., Keady, J., Nolan, M. (2007). Working together with persons with early stage dementia and their family members to design a user-friendly technology-based support service. Dementia 6: 411-434 [Abstract]
Brignell, M., Wootton, R., Gray, L. (2007). The application of telemedicine to geriatric medicine. Age Ageing 36: 369-374 [Abstract] [Full text]
Shore, J. H., Brooks, E., Savin, D. M., Manson, S. M., Libby, A. M. (2007). An Economic Evaluation of Telehealth Data Collection With Rural Populations. Psychiatr. Serv. 58: 830-835 [Abstract] [Full text]
British Thoracic Society Guideline Development Gro, (2007). Intermediate care--Hospital-at-Home in chronic obstructive pulmonary disease: British Thoracic Society guideline. Thorax 62: 200-210 [Full text]
Daucourt, V., Sicotte, C., Pelletier-Fleury, N., Petitjean, M.-E., Chateil, J.-F., Michel, P. (2006). Cost-minimization analysis of a wide-area teleradiology network in a French region. Int J Qual Health Care 18: 287-293 [Abstract] [Full text]
Wyatt, J. C, Sullivan, F. (2005). eHealth and the future: promise or peril?. BMJ 331: 1391-1393 [Full text]
Kumar, S, Tay-Kearney, M-L, Constable, I J, Yogesan, K (2005). Internet based ophthalmology service: impact assessment. Br. J. Ophthalmol. 89: 1382-1383 [Full text]
Wong, G. (2004). Email consultations in health care: Set your auto reply to "no". BMJ 329: 1046-1046 [Full text]
Debnath, D (2004). Activity analysis of telemedicine in the UK. Postgrad. Med. J. 80: 335-338 [Abstract] [Full text]
Finch, T., May, C., Mair, F., Mort, M., Gask, L. (2003). Integrating service development with evaluation in telehealthcare: an ethnographic study. BMJ 327: 1205-1209 [Abstract] [Full text]
Bishai, D. M., Ferris, D. G., Litaker, M. S. (2003). What Is the Least Costly Strategy to Evaluate Cervical Abnormalities in Rural Women? Comparing Telemedicine, Local Practitioners, and Expert Physicians. Med Decis Making 23: 463-470 [Abstract]
May, C., Harrison, R., Finch, T., MacFarlane, A., Mair, F., Wallace, P. (2003). Understanding the Normalization of Telemedicine Services through Qualitative Evaluation. J. Am. Med. Inform. Assoc. 10: 596-604 [Abstract] [Full text]
Jacklin, P B, Roberts, J A, Wallace, P, Haines, A, Harrison, R, Barber, J A, Thompson, S G, Lewis, L, Currell, R, Parker, S, Wainwright, P (2003). Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion. BMJ 327: 84- [Abstract] [Full text]
Hyler, S. E., Gangure, D. P. (2003). A Review of the Costs of Telepsychiatry. Psychiatr. Serv. 54: 976-980 [Abstract] [Full text]
(2003). OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02). Evid. Based Nurs. 6: e1-1 [Full text]
Garceau, L., Henderson, J., Davis, L.J., Petrou, S., Henderson, L.R., McVeigh, E., Barlow, D.H., Davidson, L.L. (2002). Economic implications of assisted reproductive techniques: a systematic review. Hum Reprod 17: 3090-3109 [Abstract] [Full text]
Scuffham, P., Haycox, A R, Mair, F S (2002). Systematic review of cost effectiveness in telemedicine. BMJ 325: 598-598 [Full text]

Rapid Responses:

Read all Rapid Responses

Telemedicine too important to be derailed by flawed research: Albert J Kirshen
bmj.com, 15 Jun 2002 [Full text]
Misleading title in "This week in the BMJ": Patricia A Macnair
bmj.com, 16 Jun 2002 [Full text]
Telemedicine field is ready for forthright analyses, including both positive and negative: Pamela Whitten
bmj.com, 18 Jun 2002 [Full text]
Cost-utility analysis is not always appropriate: Paul McCrone
bmj.com, 18 Jun 2002 [Full text]
Failure to compare cost effectiveness of civilian against military telemedicine is a red herring: Carl R May
bmj.com, 18 Jun 2002 [Full text]
Re: Economic evaluation is a broad church: Alan R Haycox
bmj.com, 20 Jun 2002 [Full text]
Telemedicine: Is cost effectiveness more important than clinical effectiveness and quality of life?: Giuseppe Riva
bmj.com, 20 Jun 2002 [Full text]
Half of cost effectiveness is cost: Robert C Hsiung
bmj.com, 21 Jun 2002 [Full text]
The Evidence Base Supporting The Clinical Effectiveness of Telemedicine Also Needs Strengthening: Dr Frances S Mair
bmj.com, 22 Jun 2002 [Full text]
Wasted times for telemedicine: James Sherifi
bmj.com, 26 Jun 2002 [Full text]
Quality of systematic reviews of cost-effectiveness studies: Paul A Scuffham
bmj.com, 27 Jun 2002 [Full text]
Lack of evidence for effectiveness differs from evidence of lack of effectiveness: Alan R Haycox, et al.
bmj.com, 4 Jul 2002 [Full text]