Study challenges telehealth benefits

Big priced equipment not yielding big results, research finds
By Erin McCann
12:00 AM
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With the recent push toward telehealth as a way to expand care and reduce overall expenditures, a new UK study calls into question the cost efficacy of telehealth, finding that, overall, remote monitoring comes with a bigger price tag and may not be worth it.
The study, conducted by researchers at the London School of Economics, examined more than 3,200 patients with long-term conditions, including heart failure, chronic obstructive pulmonary disease and diabetes. One group received telehealth care, while the second group received standard care for 1.5 years.
Researchers found that the cost per quality adjusted life year, a standard metric of quality of life and quantity, was nearly $140,000 more than the cost of standard care. This sum exceeds the cost effectiveness threshold of $45,600 established by the UK's National Institute for Health and Clinical Excellence. Even leaving out project management costs, telehealth reached a $120,000 price tag.
Even if, say, the price of telehealth equipment were to drop 80 percent - as equipment costs in the U.S. are estimated to be 10-50 percent less than in the UK - average costs per year would still exceed the cost of standard care. And without any impressive numbers to boast on the care improvement side of things, officials say it's no strong argument for telehealth technology.
"We're still not getting a result (that) is overwhelmingly in support of telehealth in that context," said Martin Knapp, professor of social policy at the London School of Economics and coauthor of the study, in an interview with Healthcare IT News. "I think one of the lessons for this, for any market - North American, UK or any part of the world, really - is that these bits of equipment are not cheap. They're not cheap to install; they're not cheap to monitor . . . and so, it probably does require a little bit of prior thought about who would benefit from these."
Despite the findings of LSE researchers, many previous studies have often found quite the opposite - that telemedicine not only yields better care outcomes but also has the potential to significantly decrease expenditures.
Researchers at the University of Minnesota, for example, found that for chronically ill patients receiving home care, telehealth improved patient outcomes at lower costs over face-to-face home healthcare visits. Specifically, in person care visits cost some 32 percent more per visit, per patient when compared to telehealth. However, study findings found no association between mortality/morbidity and telehealth.
Furthermore, Knapp issued a caveat toward many similar published studies that sing the praises of telemedicine. In an area of new technology, in the healthcare field at least, he explained, "quite often the initial evaluations are showing very positive results," in part because they're being promoted by "enthusiasts" and "partly because they are often funded by manufacturers." This doesn't denote falsified findings, he added, but oftentimes these groups may choose both their research sites and patients carefully, which has an effect on results.
The study conducted by researchers at the University of Minnesota, for instance, received matched funding from industry partners.
Knapp points out that the LSE study "was more of a neutral study," yielding a less positive result. "That's exactly the same thing that's happened with pharmaceutical products," he added. "When you get a bigger, more routine practice study, publically funded, independently funded, you cannot get the same positive results."
A 2009 Columbia University study examining the effects of telehealth with diabetic Medicare patients yielded similar findings. After examining the effects of telehealth with 1,665 Medicare patients with diabetes, researchers found that Medicare claims were not reduced when the technology was involved and the costs remained significantly higher due to equipment and software costs. "It remains to be shown whether, with technology available today such as cell phones, Bluetooth and portable self-monitoring devices, telemedicine-based clinical services for chronic disease management can be delivered in a cost effective way," said Steven Shea, MD, co-author of the study, in a press statement. "It will be a challenge for the healthcare provider community to be prepared to receive self monitoring data and to provide services electronically and asynchronously."
Despite these findings, however, the telehealth market has experienced explosive growth in the past few years, poised to reach nearly $6.3 billion by 2020, according to InMedica researchers. In 2013 alone, the market is expected to grow 55 percent. "The opportunities in telehealth applications are numerous," said Zachary Bujnoch, senior industry analyst at Frost and Sullivan.
Overall, though, "I just think these results mean that we should be cautious. In (the UK), the government really had hoped that this would be the solution to the future of costs of healthcare, that this would be a way of keeping the costs manageable. It isn't the solution yet. It might be the solution in a few years time, but it isn't just yet." 

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Telehealth