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Telemedicine Cost-Effectiveness for Diabetes Management: A Systematic Review

Lee JY, Lee SWH

Diabetes Technol Ther, 2018 Jul;20(7):492-500.
PMID: 29812965 DOI: 10.1089/dia.2018.0098

BACKGROUND: Telemedicine has been utilized increasingly worldwide for diabetes management, due to its potential to improve healthcare access and clinical outcomes. Few studies have assessed the economic benefits of telemedicine, which may contribute to underfunding in potentially important programs. We aim to systematically review the literature on economic evaluations of telemedicine in diabetes care, assess the quality, and summarize the evidence on driver of cost-effectiveness.
MATERIALS AND METHODS: A literature search was performed in 10 databases from inception until February 2018. All economic evaluations assessing the economic evaluation of telemedicine in diabetes were eligible for inclusion. We subsequently evaluated the study quality in terms of effectiveness measures, cost measure, economic model, as well as time horizon.
RESULTS: Of the 1877 studies identified, 14 articles were included in our final review. The healthcare providers' fees are a major predictor for total cost. In particular, the use of telemedicine for retinal screening was beneficial and cost-effective for diabetes management, with an incremental cost-effectiveness ratio between $113.48/quality-adjusted life year (QALY) and $3,328.46/QALY (adjusted to 2017 inflation rate). Similarly, the use of telemonitoring and telephone reminders was cost-effective in diabetes management.
CONCLUSIONS: Among all telemedicine strategies examined, teleophthalmology was the most cost-effective intervention. Future research is needed to provide evidence on the long-term experience of telemedicine and facilitate resource allocation.

Matched MeSH terms: Telemedicine/economics*
Evaluation of the first international teleconference in ophthalmology

Papakostopoulos D, Williams A, Ramani V, Hart CJ, Dodson K, Papakostopoulos S

J Telemed Telecare, 1999;5 Suppl 1:S17-20.
PMID: 10534828

The First International Teleconference in Ophthalmology was held during March 1998 between five sites in the UK, USA, Greece and Malaysia. ISDN transmission at 128 kbit/s was used to reduce costs while maintaining the clarity of the presented material. Specialized lecture theatres were not available at all sites and conventional halls had to be adapted for videoconferencing. For this reason initial point-to-point testing was carried with Bristol to simplify problem solving. Thereafter, a multipoint bridge was used to connect all sites together. During the conference a number of individual presentations were given, all followed by extensive discussion periods. Special instructions were given beforehand on the production of slide material, with particular reference to font sizes and colour combinations. Full use was made of various presentation media, including slides, videos and live demonstrations. The conference was attended by over 500 delegates, all of whom were specialists in ophthalmology. The technology employed was ideal for teaching purposes. However, if used in a clinical field, it should be kept in mind that the choice of transmission rate makes certain features not easily apparent in images but they become clearer when pointed out by the presenter.

Matched MeSH terms: Telemedicine/economics
Categorizing the telehealth policy response of countries and their implications for complementarity of telehealth policy

Varghese S, Scott RE

Telemed J E Health, 2004;10(1):61-9.
PMID: 15104917

Developing countries are exploring the role of telehealth to overcome the challenges of providing adequate health care services. However, this process faces disparities, and no complementarity in telehealth policy development. Telehealth has the potential to transcend geopolitical boundaries, yet telehealth policy developed in one jurisdiction may hamper applications in another. Understanding such policy complexities is essential for telehealth to realize its full global potential. This study investigated 12 East Asian countries that may represent a microcosm of the world, to determine if the telehealth policy response of countries could be categorized, and whether any implications could be identified for the development of complementary telehealth policy. The countries were Cambodia, China, Hong Kong, Indonesia, Japan, Malaysia, Myanmar, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Three categories of country response were identified in regard to national policy support and development. The first category was "None" (Cambodia, Myanmar, and Vietnam) where international partners, driven by humanitarian concerns, lead telehealth activity. The second category was "Proactive" (China, Indonesia, Malaysia, Singapore, South Korea, Taiwan, and Thailand) where national policies were designed with the view that telehealth initiatives are a component of larger development objectives. The third was "Reactive" (Hong Kong and Japan), where policies were only proffered after telehealth activities were sustainable. It is concluded that although complementarity of telehealth policy development is not occurring, increased interjurisdictional telehealth activity, regional clusters, and concerted and coordinated effort amongst researchers, practitioners, and policy makers may alter this trend.

Matched MeSH terms: Telemedicine/economics
Fulltext Information technology for patient safety

Huckvale C, Car J, Akiyama M, Jaafar S, Khoja T, Bin Khalid A, et al.

Qual Saf Health Care, 2010 Aug;19 Suppl 2:i25-33.
PMID: 20693213 DOI: 10.1136/qshc.2009.038497

BACKGROUND: Research on patient care has identified substantial variations in the quality and safety of healthcare and the considerable risks of iatrogenic harm as significant issues. These failings contribute to the high rates of potentially avoidable morbidity and mortality and to the rising levels of healthcare expenditure seen in many health systems. There have been substantial developments in information technology in recent decades and there is now real potential to apply these technological developments to improve the provision of healthcare universally. Of particular international interest is the use of eHealth applications. There is, however, a large gap between the theoretical and empirically demonstrated benefits of eHealth applications. While these applications typically have the technical capability to help professionals in the delivery of healthcare, inadequate attention to the socio-technical dimensions of their use can result in new avoidable risks to patients.
RESULTS AND DISCUSSION: Given the current lack of evidence on quality and safety improvements and on the cost-benefits associated with the introduction of eHealth applications, there should be a focus on implementing more mature technologies; it is also important that eHealth applications should be evaluated against a comprehensive and rigorous set of measures, ideally at all stages of their application life cycle.

Matched MeSH terms: Telemedicine/economics