Can economic evaluation in telemedicine be trusted? A systematic review of the literature

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Can economic evaluation in telemedicine be trusted? A systematic review of the literature Trine S Bergmo Address: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, N-9038 Tromsø, Norway Email: Trine S Bergmo - [email protected]

Published: 24 October 2009 Cost Effectiveness and Resource Allocation 2009, 7:18

doi:10.1186/1478-7547-7-18

Received: 27 April 2009 Accepted: 24 October 2009

This article is available from: http://www.resource-allocation.com/content/7/1/18 © 2009 Bergmo; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Background: Telemedicine has been advocated as an effective means to provide health care services over a distance. Systematic information on costs and consequences has been called for to support decision-making in this field. This paper provides a review of the quality, validity and generalisability of economic evaluations in telemedicine. Methods: A systematic literature search in all relevant databases was conducted and forms the basis for addressing these issues. Only articles published in peer-reviewed journals and written in English in the period from 1990 to 2007 were analysed. The literature search identified 33 economic evaluations where both costs (resource use) and outcomes (non-resource consequences) were measured. Results: This review shows that economic evaluations in telemedicine are highly diverse in terms of both the study context and the methods applied. The articles covered several medical specialities ranging from cardiology and dermatology to psychiatry. The studies analysed telemedicine in home care, and in primary and secondary care settings using a variety of different technologies including videoconferencing, still-images and monitoring (store-and-forward telemedicine). Most studies used multiple outcome measures and analysed the effects using disaggregated cost-consequence frameworks. Objectives, study design, and choice of comparators were mostly well reported. The majority of the studies lacked information on perspective and costing method, few used general statistics and sensitivity analysis to assess validity, and even fewer used marginal analysis. Conclusion: As this paper demonstrates, the majority of the economic evaluations reviewed were not in accordance with standard evaluation techniques. Further research is needed to explore the reasons for this and to address how economic evaluation in telemedicine best can take advantage of local constraints and at the same time produce valid and generalisable results.

Background There is a growing interest in shifting health care delivery from costly secondary care hospitals to community settings bringing care 'closer to home' for patients [1]. Telemedicine has been advocate