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Remote Monitoring Of Chronically Ill Patients Not Cost-Effective Says Large UK Telehealth Study

"Telehealth" technology for remote monitoring patients with long term conditions so they can live more independently at home does not appear to be more cost-effective than standard support and treatment, according to a new UK study published online in BMJ on Friday.

The study is funded by the Department of Health and led by Stanton P Newman of the School of Health Sciences, City University London.

It is part of the Whole Systems Demonstrator Trial, one the largest and most thorough investigations of telehealth and telecare ever conducted.

Telehealth and telecare allow patients with long term conditions like diabetes, heart failure and chronic obstructive pulmonary disease (COPD) to be monitored and receive a level of support away from clinics and hospitals.

For example, medical professionals can track changes in patients' blood pressure or blood-sugar levels, and send medication reminders, via special technology installed in patients' homes.

There have been suggestions that telehealth can reduce healthcare costs while also improving patients' health-related quality of life.

But while some studies have been done, there is a lack of good quality evidence on the effect of telehealth on use and cost of services, say the investigators of this latest study, which follows a BMJ study published in February that found telehealth does not improve quality of life for chronically ill patients.

For this new study, the team of UK researchers examined the costs and effectiveness of telehealth compared with standard care in 965 patients with heart failure, COPD or diabetes.

The patients were selected by their GPS and monitored for 12 months. 534 were monitored with telehealth equipment from home, and 431 received usual care with visits to their hospital or clinic.

After taking into account both health and social care costs, the researchers found the telehealth system was not cost-effective.

When added to usual care, the cost per quality adjusted life year (QALY, a measure that combines quantity and quality of life) of telehealth was £92,000.

This is well above the £30,000 per QALY threshold for cost-effectiveness set by the UK National Institute for Health and Clinical Excellence (NICE).

The researchers note that the probability of cost-effectiveness was low (11%).

Even a best-case scenario that takes into account the fact that technology like this usually becomes cheaper over time, and that during the trial the services were not working at full capacity, the researchers estimate that the probability of cost-effectiveness would be no higher than 61%, in terms of the NICE threshold.

The researchers' analysis shows that the QALY gain by patients using telehealth in addition to standard treatment and support is little different to those who receive usual care.

They conclude that "telehealth does not seem to be a cost effective addition to standard support and treatment".

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