A new report published in the British Medical Journal has cast new doubt on the cost effectiveness of telehealth in helping patients with long term conditions.
The report tested a remote telehealth system for 965 patients, with 534 receiving telehealth and 431 usual care, assessed their outcomes on NICE’s cost effectiveness formula QALY.
It found the incremental cost per QALY of telehealth when added to usual care was £92_000. With this amount, the probability of cost effectiveness was low, with just 11% willing to pay the QALY threshold held by NICE of £30_000, and half only if the threshold exceeded about £90_000.
Telehealth costs remained slightly – but not significantly – higher than usual care costs, even after assuming that equipment prices fell by 80% or telehealth services operated at maximum capacity.
The report’s authors conclude: “The QALY gain by patients using telehealth in addition to usual care was similar to that by patients receiving usual care only, and total costs associated with the telehealth intervention were higher. Telehealth does not seem to be a cost effective addition to standard support and treatment.”
Confusion over benefit
The telehealth or homecare market is worth over £1.2 billion and accounts for around 10% of the total NHS drugs bill. Growing at 23% per year, already some 150,000 to 200,000 patients are being treated at home daily in a variety of therapy areas involving a vast array of drugs and clinical support.
The UK Government has thrown its support behind telehealth, and has invested billions in the ‘3millionlives project’, which aims to bring telehealth to three million people by 2017.
And some trials have proved this to be a wise decision: In February, results from a hub pilot in Yorkshire show that telehealth can reduce hospital admissions, provide care at home and improve patient outcomes.
But the British Medical Association, the doctors’ union, has questioned the UK Government’s telehealth plan, saying it will “add significant workload for GPs” and will not likely help patients.
The government was also challenged by new analysis of its telehealth pilot scheme in 2011, which suggested that the cost per QALY gained was at a very high £88,000.
Catherine Hendersen, research officer at the London School of Economics, said: “It is unlikely that telehealth is cost effective in terms of improving quality of life, in relation to a NICE threshold of £30,000.”
Speaking on Twitter, Dr John Grumble, an NHS consultant, said of the latest telehealth data: “You can fly a plane with a computer, but you can’t manage patients just by covering them with sensors and connecting them to the web.”
Want to learn more about telehealth and how pharma can get involved? Then sign up for the PharmaTimes Clinical Homecare Workshop on 30 April at the King’s Fund here: http://bit.ly/YZKhPN
