News / BMJ study casts doubt on value of telehealth

By Seamus Ward

Telehealth does not seem to be a cost-effective addition to standard support and treatment for patients with long-term conditions, research published in the British Medical Journal has suggested.

A team of academics examined data from Department of Health whole systems demonstrator sites between May 2008 and December 2009, which covered 3,230 patients with long-term conditions such as heart failure or chronic obstructive pulmonary disease. Participants received 12 months of telehealth and monitoring services as well as standard health and social care.

Cost-effectiveness was measured as incremental cost per quality adjusted life year (QALY) gained. The research found that the cost per QALY, when added to usual care, was £92,000 – three times the ‘willingness to pay’ threshold recommended by the National Institute for Health and Clinical Excellence. When it was assumed that equipment prices fell by 80% or telehealth services operated at maximum capacity, telehealth remained slightly more costly than traditional care. However, it would be under the threshold in the most optimistic scenario – maximum operating capacity and reduced equipment prices.

The academics concluded: ‘The QALY gain by patients using telehealth in addition to usual care was similar to that by patients receiving usual care only, and total costs associated with the telehealth intervention were higher.

‘Telehealth does not seem to be a cost-effective addition to standard support and treatment,’ they added.

British Heart Foundation associate medical director Mike Knapton said telehealth and monitoring could potentially improve the quality of life for patients living with long-term conditions such as heart failure.

‘However, this large study found self-reported total health and social care costs were far greater using new telehealth technology. In the current financial climate it is difficult to see how healthcare commissioners could justify investment in telehealth on the basis of this research.’

The Department, which has committed to rolling out the technology, insisted the study covered only one part of a much wider study carried out between 2008 and 2010. In a statement, it said the whole study showed that telehealth reduced mortality, A&E attendances and emergency admissions.

‘This part of the study confirms that to introduce the technology in isolation, at high cost and in low numbers does not bring the cost reductions we believe are there to be made,’ it added.