Systematic review of cost effectiveness studies of telemedicine interventionsBMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7351.1434 (Published 15 June 2002) Cite this as: BMJ 2002;324:1434
Table A Details of articles examining cost effectiveness of telemedicine for healthcare delivery that qualified for full review
Authors Formal hypothesis Perspective Method Comparator Medical evidence Costs Benefits Timing Marginal Sensitivity Local applicability Overall comments Bailes et al (1997)w4 No None CMA Yes (hypothetical) AEWSE DC PS No No No Insufficient data Unsatisfactory. Claims poorly supported Bergmo et al (1997)w5 No Yes, societal CMA Yes AE-SE DC, IC, PC Knowledge transfer Yes Yes, limited Yes, workload variations Limited by geography Relatively high quality study discussing broader effects of telemedicine but based on assumption rather than fact Bergmo et al (1996)w6 No Yes, public health service CMA Yes AEWSE DC NA Yes Yes, limited Yes Geographical limitations Useful cost analysis but based on assumption rather than fact Brunicardi (1998)w8 No Yes, prison service costs CMA Yes AEWSE DC to prison service Benefits to prison service (such as greater security, fewer litigation) Yes No Yes Limited to prison service. Largely based on assumptions but potentially useful analysis of one application of telemedicine Chodroff (1999)w13 No None CA No AE-SE DC Cost offsets (such as air transport avoided) No No No Limited by lack of detail Limited analysis, lack of information provided Crowe et al (1996)w14 No Not specified CA None NA DC NA Yes Yes, limited Yes Geographical limitations 3 month pilot studying feasibility rather than cost effectiveness Darkins et al (1996)w15 No Not specified CMA Yes (hypothetical) AEWSE DC Discussed but not measured No No No Based in UK but insufficient data Interesting prospective cohort study, insufficient data overall Davis (1997)w16 No Not specified CMA Yes (hypothetical) AEWSE DC None No Yes, limited Yes, related to workload Limited by lack of detail, insufficient data Useful analysis that requires long term examination of costs and clinical efficacy Doolittle et al (1998)w19 No Yes, hospital perspective CMA Yes NA DC Not explored Yes No No Restricted cost and effectiveness analysis, but rural US setting reduces applicability. Useful preliminary analysis, examining costs of delivering oncology services by 3 different methods. Further analyses required Friedman et al (1996)w24 No Not specified CEA (RCT) Yes in RCT NA DC Improved adherence and reduced diastolic blood pressure No No No US based RCT, therefore may be applicable for target age group (³ 60 years) Valuable as results gained in RCT but limited analysis of health service utilisation costs, particularly over long term Halvorsen et al (1996)w26 No Yes, societal CMA Yes (hypothetical) AEWSE DC, IC, PC NA Yes Yes Yes Geographical limitations but randomly selected, therefore may be broadly applicable Relatively detailed and comprehensive analysis that fails to find cost savings but argues in favour of teleradiology on grounds of access and quality of service Loane et al (1999)w31* No Yes, patient CA (RCT) Yes AE-SE Patient borne costs NA No No No Analyses potential patient costs (time or distance travelled without explicit costs), limited analysis Malone et al (1998)w33 No Not specified CMA Yes AE-SE DC NA No No No Limited by narrow focus of US study Costs presented in effort to suggest possible areas of savings that may justify consideration of telemedicine McCue et al (1997)w34 No Yes, prison service CMA Yes NA DC to prison service Cost savings to prison service No No Limited attempt to analyse break even point Applicability limited to prison service Useful but limited study, much broader analysis required of costs and benefits to increase generalisability McCue et al (1998)w35 No Yes, prison service CMA Yes, hypothetical NA DC to prison service Cost savings to prison service No No No Applicability limited to prison service Useful but limited study, further exploration required of long term impact Preston (1995)w39 Limited None CA Yes (hypothetical) NA DC Offset savings Yes, limited No No Limited by restricted cost analysis Specific to local situation, does not address outcome, hypothetical comparator Rendina et al (1998)w42 Yes Yes, medical centre CEA Yes NA DC Reduced hospital length of stay equated with benefit Yes No No US analysis, limited by sample size Interesting preliminary analyses, but larger study with more detailed analyses required Stoeger et al (1997)w48 No Not specified CMA Yes (hypothetical) AEWSE DC NA No No No Geographical country limitations Narrow cost based evaluation Takizawa et al (1998)w50 No None Partial CA Yes NA Partial DC Reduced treatment costs No No No Geographical limitations and limited evaluation Method of economic analysis flawed Trott et al (1998)w51 Yes Not specified CMA Yes (hypothetical) AEWSE DC Benefits equated with potential costs savings No No No Geographical limitations Specific to Australian context based on estimated costs not real cost data Vincent et al (1997)w52 No Not specified CMA Yes (hypothetical) Yes, adequately shown DC Benefits equated with reduced ER use and improved healthcare delivery No No No US analysis with limited applicability in UK Useful initial analysis, but more detailed examination of long term impacts required Wootton et al (2000)w53* No Yes, societal CEA (RCT) Yes AE-SE DC, IC, PC Knowledge transfer and subsequent treatment Yes Yes, limited Yes Good applicability in UK RCT, which is valuable. Takes a broad perspective and is a useful contribution to the literature Wu et al (1995)w54 No Not specified CEA Yes AE-SE DC Benefits equated with clinical value No No No US analysis with geographical limitations Useful preliminary study but requires broader analysis with larger sample over longer time Zincone et al (1997)w55 No Yes, prison and societal CMA Yes AEWSE DC Improved security and less litigation Yes Yes, limited Yes Limited to prison service Useful preliminary analysis in specific prison context and specific contractual arrangement
*These two reports describe different outcome measures but refer to the same trial and used some of the same subjects.
DC=Direct costs (immediate costs to provider such as cost of equipment and line rental).
PS=Potential savings (anticipated reduction in costs, such as travel or staff time).
IC=Indirect costs (wider implications of service delivery options, such as improved productivity at work).
PC=Privately borne costs (such as travel and time costs imposed on patient).
CA=Cost analysis (simple adding of cost elements).
CMA=Cost minimisation analysis (simple cost comparison of options for service delivery).
CEA=Cost effectiveness analysis (examination of cost or item of service delivery).
AE-SE=Assumes equivalence, with supporting evidence.
AEWSE-Assumes equivalence without supporting evidence.
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