Summary
The economic effects of home telehealth can be discussed using direct or indirect measures of costs and cost savings. Direct measures include figures such as cost per patient, cost per telehealth unit, and annual costs. Examples of indirect measures are probability of patient hospitalization, number of emergency room visits, and other types of health service use. Though a formal economic analysis would typically assign these services a fixed dollar value, other study designs often report changes in service use without attempting to translate these changes into costs or cost savings.
The few cost analyses that were found, none of which took place in Canada, demonstrate that choice of technology and design of intervention have a dramatic impact on costs. It appears that some forms of telehealth can be less expensive than usual care, but the high equipment costs cited in other analyses imply that cost savings for some programs, should they exist, might only become apparent over the course of years or decades.
The possibility of a large delay in the realization of economic benefit is not unique to programs for type 1 diabetes, but the nature of the condition may increase the lag time. Though there are certainly costs associated with the ongoing management of type 1 diabetes, a large proportion of the burden that it imposes on the health care system lies in long-term complications. Whether home telehealth can reduce the occurrence of these complication remains to be seen, although findings of short-term improvements in HbA1c have promising implications.
Evidence on the effects of home telehealth on service use severely lacking. That which has been published tends to be short on details. Our search retrieved no information on the effects of home telehealth on use of emergency services, specialist appointments, or hospitalization rates.
Details
Emergency Services Use
No studies reported on emergency services use.
(Re-) Hospitalizations
No studies reported on hospitalizations or re-hospitalizations.
Primary Care Use
No studies reported on primary care use.
Specialist Care Use
No studies reported on specialist care use.
Telehealth Costs and Cost Comparisons
Summary: Evidence on the economic outcomes of telehealth is severely lacking. The 3 studies that report economic outcomes were all located in western Europe. Without more comprehensive and transparent reporting, the extent of their applicability in the Canadian context is uncertain. There is not yet sufficient evidence to draw conclusions on the cost effectiveness of home-based telehealth in managing type 1 diabetes.
Study Details: The most thorough economic analysis was found in Jansa et al. (2006), where an economic comparison of telehealth and usual care included costs of equipment, patient training, and appointment time. Costs over the intervention period were favourable to the telehealth group: 347-421 Euros for appointments in the intervention group vs. 695 Euros for the standard intensive treatment plan. It is not clear whether the figures provided are per patient or per group, or whether they are yearly costs or stem only from the 6-month intervention period. It is also unclear whether patient time savings and travel costs were included in the analysis.
Gomez (2008) modelled annual expenses arising from use of the INCA system[1] by a 19-year old with type 1diabetes and no complications. Annual cost to the German health care system was estimated at 13,255 Euros, which was 7348 Euros more than a year of treatment with standard insulin pump therapy. Estimated costs in Rossi et al. (2010) were considerably lower: extrapolating costs for the intervention period yields an estimated yearly cost of 16 Euros per patient. However, this figure is based solely on cost per text message, and does not include costs incurred in provider time, patient training, or equipment.
[1] A closed-loop system that incorporates an insulin pump, a patient-provider communication system, and a variety of health-related logbooks
