Doctors′ organ, the British Medical Journal (BMJ) has come out strongly against one of the Health Secretary′s favoured technologies – telehealth. It has published results of a trial of 965 patients it claims shows the use of technology to monitor and support patients in their homes “does not seem to be a cost effective addition to standard support and treatment for patients with long term conditions.”
This is a blow for the government, which as recently as November 2012 suggested telehealth could be a powerful tool for supporting patients with chronic conditions. It′s also doubly painful, as the critical research was on the NHS′ own Whole Systems Demonstrator Trial - one of the largest and most comprehensive investigations of telehealth and telecare ever conducted in the UK.
Telehealth uses technology to help people with health problems
The BMJ notes that telehealth uses technology to help people with health problems live more independently at home - for example, it means blood pressure or blood glucose levels can be measured at home and electronically transmitted to a health professional, reducing the need for hospital visits. It also reminds us that, “telehealth has been promoted to reduce healthcare costs while improving health related quality of life, but there is very little good quality evidence on the effect of telehealth on service use and costs.”
To test these claims, it says a team of its researchers examined the cost effectiveness of telehealth compared with usual care over 12 months in 965 patients with a long term condition (one of heart failure, chronic obstructive pulmonary disease or diabetes). Of the sample, about half, 534, were provided telehealth equipment and support, while 431 received the usual care.
It claims to have found that the cost per quality adjusted life year - a combined measure of quantity and quality of life – of telehealth when added to usual care was £92,000 – a figure it says is “well above” the cost effectiveness threshold of £30,000 set by the UK National Institute for Health and Clinical Excellence. And even when the effects of equipment price reductions and increased working capacity of services were combined, the probability that telehealth is cost effective was only about 61% and that the probability of cost effectiveness was low - 11%. The results took account of costs to both health and social care systems, state the research team.
The most of studies into the technology´s use came from US
It also claims that most of the previous positive studies into the technology′s use came from the US, was based on very small numbers of patients or were funded by the healthcare/technology industry. On the basis of this data, the study′s authors conclude that “telehealth does not seem to be a cost effective addition to standard support and treatment”.
Commenting on the study in a report on the BBC website today, one of its authors, Professor Martin Knapp of the London School of Economics and Political Science, said there was likely to be a place for telehealth, but there remained a question about how to target patients who would most benefit.
And one of the research team, Dr Mike Knapton of The British Heart Foundation, added: “In the current financial climate it is difficult to see how health care commissioners could justify investment in telehealth on the basis of this research.” The government rejects the findings. Responding to the story, The Department of Health is quoted as saying: "This is only one part of a much wider study carried out between 2008 and 2010. The whole study showed that using telehealth reduces mortality by 45%, A&E attendances by 15% and emergency admissions by 20%. This part of the study confirms that to introduce the technology in isolation, at high cost and in low numbers does not bring the cost reductions we believe are there to be made.
“That is why our approach, known as the three million lives initiative, is different. It is about bringing in telehealth at scale and will create improvements in services, care and costs."
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Quelle/Source: British Journal of Healthcare Computing, 22.03.2013
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