Intended for healthcare professionals

Details of studies


 
 
 
  
Table A Details of articles examining cost effectiveness of telemedicine for healthcare delivery that qualified for full review
 
Authors
Formal hypothesis
Perspective
Method
Comparator
Medical evidence
Costs
Benefits
Timing
Marginal
Sensitivity
Local applicability
Overall comments
Bailes et al (1997)w4
No
None
CMA
Yes (hypothetical)
AEWSE
DC
PS
No
No
No
Insufficient data
Unsatisfactory. Claims poorly supported
Bergmo et al (1997)w5
No
Yes, societal
CMA
Yes
AE-SE
DC, IC, PC
Knowledge transfer
Yes
Yes, limited
Yes, workload variations
Limited by geography
Relatively high quality study discussing broader effects of telemedicine but based on assumption rather than fact
Bergmo et al (1996)w6
No
Yes, public health service
CMA
Yes
AEWSE
DC
NA
Yes
Yes, limited
Yes
Geographical limitations
Useful cost analysis but based on assumption rather than fact
Brunicardi (1998)w8
No
Yes, prison service costs
CMA
Yes
AEWSE
DC to prison service
Benefits to prison service (such as greater security, fewer litigation)
Yes
No
Yes
Limited to prison service.
Largely based on assumptions but potentially useful analysis of one application of telemedicine
Chodroff (1999)w13
No
None
CA
No
AE-SE
DC
Cost offsets (such as air transport avoided)
No
No
No
Limited by lack of detail
Limited analysis, lack of information provided
Crowe et al (1996)w14
No
Not specified
CA
None
NA
DC
NA
Yes
Yes, limited
Yes
Geographical limitations
3 month pilot studying feasibility rather than cost effectiveness
Darkins et al (1996)w15
No
Not specified
CMA
Yes (hypothetical)
AEWSE
DC
Discussed but not measured
No
No
No
Based in UK but insufficient data
Interesting prospective cohort study, insufficient data overall
Davis (1997)w16
No
Not specified
CMA
Yes (hypothetical)
AEWSE
DC
None
No
Yes, limited
Yes, related to workload
Limited by lack of detail, insufficient data
Useful analysis that requires long term examination of costs and clinical efficacy
Doolittle et al (1998)w19
No
Yes, hospital perspective
CMA
Yes
NA
DC
Not explored
Yes
No
No
Restricted cost and effectiveness analysis, but rural US setting reduces applicability.
Useful preliminary analysis, examining costs of delivering oncology services by 3 different methods. Further analyses required
Friedman et al (1996)w24
No
Not specified
CEA (RCT)
Yes in RCT
NA
DC
Improved adherence and reduced diastolic blood pressure
No
No
No
US based RCT, therefore may be applicable for target age group (³ 60 years)
Valuable as results gained in RCT but limited analysis of health service utilisation costs, particularly over long term
Halvorsen et al (1996)w26
No
Yes, societal
CMA
Yes (hypothetical)
AEWSE
DC, IC, PC
NA
Yes
Yes
Yes
Geographical limitations but randomly selected, therefore may be broadly applicable
Relatively detailed and comprehensive analysis that fails to find cost savings but argues in favour of teleradiology on grounds of access and quality of service
Loane et al (1999)w31*
No
Yes, patient
CA (RCT)
Yes
AE-SE
Patient borne costs
NA
No
No
No
 
Analyses potential patient costs (time or distance travelled without explicit costs), limited analysis
Malone et al (1998)w33
No
Not specified
CMA
Yes
AE-SE
DC
NA
No
No
No
Limited by narrow focus of US study
Costs presented in effort to suggest possible areas of savings that may justify consideration of telemedicine
McCue et al (1997)w34
No
Yes, prison service
CMA
Yes
NA
DC to prison service
Cost savings to prison service
No
No
Limited attempt to analyse break even point
Applicability limited to prison service
Useful but limited study, much broader analysis required of costs and benefits to increase generalisability
McCue et al (1998)w35
No
Yes, prison service
CMA
Yes, hypothetical
NA
DC to prison service
Cost savings to prison service
No
No
No
Applicability limited to prison service
Useful but limited study, further exploration required of long term impact
Preston (1995)w39
Limited
None
CA
Yes (hypothetical)
NA
DC
Offset savings
Yes, limited
No
No
Limited by restricted cost analysis
Specific to local situation, does not address outcome, hypothetical comparator
Rendina et al (1998)w42
Yes
Yes, medical centre
CEA
Yes
NA
DC
Reduced hospital length of stay equated with benefit
Yes
No
No
US analysis, limited by sample size
Interesting preliminary analyses, but larger study with more detailed analyses required
Stoeger et al (1997)w48
No
Not specified
CMA
Yes (hypothetical)
AEWSE
DC
NA
No
No
No
Geographical country limitations
Narrow cost based evaluation
Takizawa et al (1998)w50
No
None
Partial CA
Yes
NA
Partial DC
Reduced treatment costs
No
No
No
Geographical limitations and limited evaluation
Method of economic analysis flawed
Trott et al (1998)w51
Yes
Not specified
CMA
Yes (hypothetical)
AEWSE
DC
Benefits equated with potential costs savings
No
No
No
Geographical limitations
Specific to Australian context based on estimated costs not real cost data
Vincent et al (1997)w52
No
Not specified
CMA
Yes (hypothetical)
Yes, adequately shown
DC
Benefits equated with reduced ER use and improved healthcare delivery
No
No
No
US analysis with limited applicability in UK
Useful initial analysis, but more detailed examination of long term impacts required
Wootton et al (2000)w53*
No
Yes, societal
CEA (RCT)
Yes
AE-SE
DC, IC, PC
Knowledge transfer and subsequent treatment
Yes
Yes, limited
Yes
Good applicability in UK
RCT, which is valuable. Takes a broad perspective and is a useful contribution to the literature
Wu et al (1995)w54
No
Not specified
CEA
Yes
AE-SE
DC
Benefits equated with clinical value
No
No
No
US analysis with geographical limitations
Useful preliminary study but requires broader analysis with larger sample over longer time
Zincone et al (1997)w55
No
Yes, prison and societal
CMA
Yes
AEWSE
DC
Improved security and less litigation
Yes
Yes, limited
Yes
Limited to prison service
Useful preliminary analysis in specific prison context and specific contractual arrangement

*These two reports describe different outcome measures but refer to the same trial and used some of the same subjects.

DC=Direct costs (immediate costs to provider such as cost of equipment and line rental).

PS=Potential savings (anticipated reduction in costs, such as travel or staff time).

IC=Indirect costs (wider implications of service delivery options, such as improved productivity at work).

PC=Privately borne costs (such as travel and time costs imposed on patient).

CA=Cost analysis (simple adding of cost elements).

CMA=Cost minimisation analysis (simple cost comparison of options for service delivery).

CEA=Cost effectiveness analysis (examination of cost or item of service delivery).

NA=Not addressed

AE-SE=Assumes equivalence, with supporting evidence.

AEWSE-Assumes equivalence without supporting evidence.

ER=Emergency room.