Martin knapp, The cost-effectiveness of telecare and telehealth


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The cost-effectiveness of telecare and telehealth
Telehealth & telecare-congres
2 - 3 maart 2011

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Martin knapp, The cost-effectiveness of telecare and telehealth

  1. 1. King’s Fund. March 2011The cost-effectiveness of telecare and telehealth Martin Knapp, Catherine Henderson, Ariane Buescher, Jose-Luis Fernandez o London School of Economics and Political Science o Institute of Psychiatry at King’s College London o NIHR School for Social Care Research
  2. 2. Structureo Contexto Systematic review of economic evidenceo Lessons from the reviewo WSD
  3. 3. Contexto Ageing - growing needso Rising aspirationso Public sector resource constraintso Private resources also under pressureo Even tougher to coordinate across sectors and systems …o … and to move beyond very short time horizons
  4. 4. Systematic reviewo Telehealth and telecare interventionso Searched sstematic reviews, meta-analyses and individual studieso All designs: RCTs, cohorts, quasi- experimentso English language, 2000-2011o Economic dimensions, e.g. service use, costs, cost-effectivenesso 27 systematic reviews foundo Paper currently being prepared for publication (if we have something to add to existing reviews)
  5. 5. Reviews of economics evidenceBensink M, Hailey D. et al. (2006) A systematic review of successes and failures in home telehealth: preliminary results. J Telemed Telecare; 12: 8-16 [TH]Bergmo, T. (2009) Can economic evaluation in telemedicine be trusted? A systematic review of the literature. Cost effectiveness and resource allocation; 7:18 [TM]Davalos M., French M et al. (2009) Economic evaluation . J Telemed Telecare; General consensus  the evidence 15(10):933-948 [TH]Jennett P, Hall L (2003) The socio-economic impact of telehealth: A systematic review. base is methodologically weak … Journal of Telemedicine and Telecare; 9(6): 311-320. [TH]Kairy, D., P. Lehoux, et al.(2009) A systematic review of clinical outcomes, clinical … and so it is hard to draw clear process, healthcare utilization and costs associated with telerehabilitation. Disability and Rehabilitation; 31(6): 427-447. [TR] conclusions from available studies.Polisena J, Tran K et al. (2009b). Home telehealth for chronic disease management: A systematic review and an analysis of economic evaluations. International Journal of What areas of weakness? Technology Assessment in Health Care; 25(3): 339-349. [TH]Rojas, S., Gagnon, M. P. (2008) A systematic review of the key indicators for assessing telehomecare cost-effectiveness. Telemedicine and e-Health; 14(9): 896-904 [TC]Seto, E. (2008) Cost comparison between telemonitoring and usual care of heart failure: a systematic review. Telemedicine and e-Health; 14(7): 679-686 [TH]Wade, V. A., J. Karnon, et al. (2010) A systematic review of economic analyses of telehealth services using real time video communication. BMC Health Services Research; 10:1-13 [TH]
  6. 6. Lessons from the review: equityA. Forgetting equity Much emphasis on 3 Es: - economy (what goes into providing a service) People with long-term needs/conditions are - efficiency (level of output relative to input) disproportionately in the lower socioeconomic - effectiveness (the groups … impact on outcomes) … which makes the Very little on the 4th E: distributional issue - equity especially important. Distribution of burdens and outcomes (linked closely to needs)
  7. 7. Lessons from the review: outputsA. Forgetting equity Budget reports measure spending (=costs)B. Outputs (alone) Activity stats and PIsThis is especially measure ‘busy-ness’pertinent if costs are and people supportedfound to increase; (=outputs)or if evaluations are But the primary concerntoo short term; or if of health and social care(narrow) ‘efficiency’ is impact on individuals’is the dominant health, quality of life,sentiment wellbeing = outcomes
  8. 8. Lessons from the review: silosA. Forgetting equity Budget cuts could encourage narrow self-B. Outputs (alone) interest.C. Silos But many service users and families have wide- A ‘whole systems’ ranging needs … approach is needed … and hence they use a And research needs to range of supports examine evidence from and services. different perspectives (agency, individual, Evidence often fails to societal …) mirror this multi-agency / budget reality
  9. 9. Lessons from the review: horizonsA. Forgetting equity Effective interventions could head off long-B. Outputs (alone) term problems + costs.C. Silos Hard-pressed decision-D. Short-termism makers and researchers focus on short-term But consequences of TC (TH too?) could be most pronounced in long- term Explore longer-term simulation modelling?
  10. 10. Lessons from the review: averagesA. Forgetting equity Research reports averages (costs,B. Outputs (alone) outcomes).C. Silos But who is this ‘averageD. Short-termism user or patient’ ?E. The average user Need to understand individual variations in outcomes and costs… For whom is this intervention effective and cost-effective?
  11. 11. Lessons from the review: samples Research often limitedA. Forgetting equity by samples that are tooB. Outputs (alone) small to pick up significant differences.C. Silos There is a general issueD. Short-termism of statistical power, butE. The average user it is a particular issue inF. Small samples cost-effectiveness studies.
  12. 12. Lessons from the review: ‘good’ costsA. Forgetting equity Costs are seen as bad – saving money is a goodB. Outputs (alone) thing.C. Silos But many people withD. Short-termism long-term needs are under-supported, soE. The average user interventions thatF. Small samples identify unmet needs could increase costs.G. Good/bad costs This could be good. To check we must look at cost-effectiveness
  13. 13. Lessons from the review: comparatorsA. Forgetting equity Evidence almost alwaysB. Outputs (alone) needs to be seen in context – needs toC. Silos include a comparator.D. Short-termism There are still studiesE. The average user that examine impacts of one intervention in theF. Small samples absence of a controlG. Good/bad costs group.H. Roman Emperor
  14. 14. Lessons from the review: locationA. Forgetting equity Most evidence comesB. Outputs (alone) from North America – where health and careC. Silos systems are veryD. Short-termism different from here; also prices different.E. The average user Outcome results mightF. Small samples transfer more readilyG. Good/bad costs than cost or cost- effectiveness results.H. Roman Emperor Need to set findings inI. Transportability context of local systems
  15. 15. Lessons from the review: interestsA. Forgetting equity Of course, interested parties will commissionB. Outputs (alone) research:C. Silos • manufacturersD. Short-termism • governmentsE. The average user • lobbying groups etcF. Small samples Need to be aware of theG. good/bad costs funding source whenH. Roman Emperor judging the quality of evidenceI. TransportabilityJ. Interest groups
  16. 16. WSD: economic questionsi. What are the costs of the TH/TC interventions themselves?ii. What are the levels of service use (and their associated costs) for TH/TC users?iii. Are individual, area, other characteristics associated with service use and cost variations?iv. Is TH/TC cost-effective? I.e. how do the costs and outcomes compare? Are the outcomes of TH/TC worth the costs?v. And for whom is TH/TC (most) cost-effective?vi. What are the marginal productivities of support and treatment services for TH/TC users?
  17. 17. ContactsMartin Knapp Henderson