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Systematic review of cost effectiveness studies of telemedicine interventions

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7351.1434 (Published 15 June 2002) Cite this as: BMJ 2002;324:1434

Data supplement


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    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).

    NA=Not addressed

    AE-SE=Assumes equivalence, with supporting evidence.

    AEWSE-Assumes equivalence without supporting evidence.

    ER=Emergency room.

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