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COST-EFFECTIVENESS OF TELEHEALTH INTERVENTIONS FOR CHRONIC HEART FAILURE PATIENTS: A LITERATURE REVIEW

  • Andrija S. Grustam (a1), Johan L. Severens (a2), Jan van Nijnatten (a3), Ron Koymans (a4) and Hubertus J. M. Vrijhoef (a5)...

Abstract

Objectives: Evidence exists that telehealth interventions (e.g., telemonitoring, telediagnostics, telephone care) in disease management for chronic heart failure patients can improve medical outcomes, and we aim to give an overview of the cost-effectiveness of these interventions.

Methods: Based on the literature search on “heart failure” in combination with “cost” and “telehealth” we selected 301 titles and abstracts. Titles and abstracts were screened for a set of inclusion criteria: telehealth intervention, heart failure as the main disease, economic analysis present and a primary study performed. In the end, thirty-two studies were included for full reading, data extraction, and critical appraisal of the economic evaluation.

Results: Most studies did not present a comprehensive economic evaluation, consisting of the comparison of both costs and effects between telehealth intervention and a comparator. Data on telehealth investment costs were lacking in many studies. The few studies that assessed costs and consequences comprehensively showed that telehealth interventions are cost saving with slight improvement in effectiveness, or comparably effective with similar cost to usual care. However, the methodological quality of the studies was in general considered to be low.

Conclusions: The cost-effectiveness of telehealth in chronic heart failure is hardly ascertained in peer reviewed literature, the quality of evidence is poor and there was a difficulty in capturing all of the consequences/effects of telehealth intervention. We believe that without full economic analyses the cost-effectiveness of telehealth interventions in chronic heart failure remains unknown.

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1. Benatar, D, Bondmass, M, Ghitelman, J, Avitall, B. Outcomes of chronic heart failure. Arch Intern Med. 2003;163:347352.
2. WHO. Legal frameworks for eHealth. 2012. http://whqlibdoc.who.int/publications/2012/9789241503143_eng.pdf (accessed June 12, 2012).
3. Steventon, A, Bardsley, M, Billings, J, et al. Effect of telehealth on use of secondary care and mortality: Findings from the Whole System Demonstrator cluster randomised trial. BMJ. 2012;344:e3874.
4. Klersy, C, De Silvestri, A, Gabutti, G, et al. Economic impact of remote patient monitoring: An integrated economic model derived from a meta-analysis of randomized controlled trials in heart failure. Eur J Heart Fail. 2011;13:450459.
5. Inglis, SC, Clark, RA, McAlister, FA, Stewart, S, Cleland, JGF. Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: Abridged Cochrane Review. Eur J Heart Fail. 2011;13:10281040.
6. Kobb, R, Chumbler, NR, Brennan, DM, Rabinowitz, T. Home telehealth: Mainstreaming what we do well. Telemed J E Health. 2008;14:977981.
7. Drummond, MF, Sculpher, MJ, Torrance, GW, O'Brien, BJ, Stoddart, GL. Methods for the economic evaluation of health care programs. Cambridge: Oxford University Press; 2005.
8. Dávalos, ME, French, MT, Burdick, AE, Simmons, SC. Economic evaluation of telemedicine: Review of the literature and research guidelines for benefit–cost analysis. Telemed J E Health. 2009;15:933948.
9. WHO. Telemedicine: Opportunities and developments in Member States. Geneva: World Health Organization; 2008. http://www.who.int/goe/publications/goe_telemedicine_2010.pdf (accessed January 12, 2013).
10. Khand, A, Gemmel, I, Clark, AL, Cleland, JGF. Is the prognosis of heart failure improving? J Am Coll Cardiol. 2000;36: 22842286.
11. Cleland, J, Swedberg, K, Follath, F, et al. The EuroHeart Failure survey programme—a survey on the quality of care among patients with heart failure in Europe Part 1: Patient characteristics and diagnosis. Eur Heart J. 2003;24:442463.
12. Perednia, DA, Allen, A. Telemedicine technology and clinical applications. JAMA. 1995;273:483488.
13. Wootton, R, Hebert, MA. What constitutes success in telehealth? J Telemed Telecare. 2001;7(Suppl 2):37.
14. CAS and FIZ Karlsruhe. STN International. 2013. http://www.stn-international.de (accessed August 7, 2012).
15. The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions. 2013. http://www.cochrane-handbook.org/ (accessed February 7, 2013).
16. Riegel, B, Carlson, B, Glaser, D, Kopp, Z, Romero, TE. Standardized telephonic case management in a hispanic heart failure population. Dis Manag Health Outcomes. 2002;10:241249.
17. Riegel, B, Carlson, B, Glaser, D, Romero, T. Randomized controlled trial of telephone case management in Hispanics of Mexican origin with heart failure. J Cardiac Fail. 2006;12:211219.
18. Riegel, BCB. Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Arch Intern Med. 2002;162:705712.
19. Wootton, R, Gramotnev, H, Hailey, D. A randomized controlled trial of telephone-supported care coordination in patients with congestive heart failure. J Telemed Telecare. 2009;15:182186.
20. Wootton, R, Gramotnev, H, Hailey, D. Telephone-supported care coordination in an Australian veterans population: A randomized controlled trial. J Telemed Telecare. 2010;16:5762.
21. Finkelstein, SM, Speedie, SM, Potthoff, S. Home telehealth improves clinical outcomes at lower cost for home healthcare. Telemed J E Health. 2006;12:128136.
22. Johnston, B, Wheeler, L, Deuser, J, Sousa, KH. Outcomes of the Kaiser Permanente Tele-Home Health Research Project. Arch Fam Med. 2000;9:4045.
23. Noel, HC, Vogel, DC, Erdos, JJ, Cornwall, D, Levin, F. Home telehealth reduces healthcare costs. Telemed J E Health. 2004;10:170183.
24. Peikes, D, Chen, A, Schore, J, Brown, R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries. JAMA. 2009;301: 603618.
25. Wennberg, DE, Marr, A, Lang, L, O'Malley, S, Bennett, G. A randomized trial of a telephone care-management strategy. N Engl J Med. 2010;363:12451255.
26. Myers, S, Grant, RW, Lugn, NE, Holbert, B, Kvedar, JC. Impact of home-based monitoring on the care of patients with congestive heart failure. Home Health Care Manag Pract. 2006;18:444451.
27. Berg, GD, Wadhwa, S, Johnson, AE. A matched-cohort study of health services utilization and financial outcomes for a heart failure disease-management program in elderly patients. J Am Geriatr Soc. 2004;52:16551661.
28. Chen, YH, Ho, YL, Huang, HC, et al. Assessment of the clinical outcomes and cost-effectiveness of the management of systolic heart failure in Chinese patients using a home-based intervention. J Int Med Res. 2010;38:242252.
29. Heidenreich, PA, Ruggerio, CM, Massie, BM. Effect of a home monitoring system on hospitalization and resource use for patients with heart failure. Am Heart J. 1999;138:633640.
30. Hebert, PL, Sisk, JE, Wang, JJ, et al. Cost-effectiveness of nurse-led disease management for heart failure in an ethnically diverse urban community. Ann Intern Med. 2008;149:540548.
31. Hudson, LR, Hamar, GB, Orr, P, et al. Remote physiological monitoring: Clinical, financial, and behavioral outcomes in a heart failure population. Dis Manag. 2005;8:372381.
32. Vaccaro, J, Cherry, J, Harper, A, O'Connell, M. Utilization reduction, cost savings, and return on investment for the pacifiCare chronic heart failure program,” Taking Charge of Your Heart Health”. Dis Manag. 2001;4:131142.
33. Ho, Y-L, Hsu, T-P, Chen, C-P, et al. Improved cost-effectiveness for management of chronic heart failure by combined home-based intervention with clinical nursing specialists. J Formos Med Assoc. 2007;106:313319.
34. Giordano, A, Scalvini, S, Zanelli, E, et al. Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure. Int J Cardiol. 2009;131:192199.
35. Scalvini, S, Capomolla, S, Zanelli, E, et al. Effect of home-based telecardiology on chronic heart failure: Costs and outcomes. J Telemed Telecare. 2005;11(Suppl 1):1618.
36. Dar, O, Riley, J, Chapman, C, et al. A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: Results of the Home-HF study. Eur J Heart Fail. 2009;11:319325.
37. Copeland, LA, Berg, GD, Johnson, DM, Bauer, RL. An intervention for VA patients with congestive heart failure. Am J Manag Care. 2010;16:158165.
38. Smith, B, Hughes-Cromwick, PF, Forkner, E, Galbreath, AD. Cost-effectiveness of telephonic disease management in heart failure. Am J Manag Care. 2008;14:106115.
39. Galbreath, AD, Krasuski, RA, Smith, B, et al. Long-term healthcare and cost outcomes of disease management in a large, randomized, community-based population with heart failure. Circulation. 2004;110:35183526.
40. Schwarz, KA, Mion, LC, Hudock, D, Litman, G. Telemonitoring of heart failure patients and their caregivers: A pilot randomized controlled trial. Progr Cardiovasc Nurs. 2008;23:1826.
41. Soran, OZ, Feldman, AM, Piña, IL, et al. Cost of medical services in older patients with heart failure: Those receiving enhanced monitoring using a computer-based telephonic monitoring system compared with those in usual care: The heart failure home care trial. J Card Fail. 2010;16:859866.
42. Tompkins, C, Orwat, J. A randomized trial of telemonitoring heart failure patients. J Healthc Manag. 2010:55:312322.
43. Jerant, A, Azari, R, Nesbitt, T. Reducing the cost of frequent hospital admissions for congestive heart failure. Med Care. 2001;39:12341245.
44. Capomolla, S, Pinna, G, Larovere, M, et al. Heart failure case disease management program: A pilot study of home telemonitoring versus usual care. Eur Heart J Suppl. 2004;6:F9198.
45. Laramee, AS, Levinsky, SK, Sargent, J, Ross, R, Callas, P. Case management in a heterogeneous congestive heart failure population: A randomized controlled trial. Arch Intern Med. 2003;163:809817.
46. Dunagan, WC, Littenberg, B, Ewald, GA, et al. Randomized trial of a nurse-administered, telephone-based disease management program for patients with heart failure. J Card Fail. 2005;11:358365.
47. Kasper, EK, Gerstenblith, G, Hefter, G, et al. A randomized trial of the efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmission. J Am Coll Cardiol. 2002;39:471480.
48. Black, WC. The CE plane a graphic representation of cost-effectiveness. Med Decis Making. 1990;10:212214.
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