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GPs go forth

Government's telecare scheme costs 10 times NHS cost-effectiveness threshold

The Government’s flagship telecare scheme to improve social and health care for vulnerable people costs 10 times the usual accepted level for a cost-effective intervention, researchers have found.

A study has shown that providing people with additional telecare costs nearly £300,000 for each quality-adjusted life-year (QALY) gained as a result, compared with the £30,000 threshold that the NHS is usually willing to pay when introducing new interventions.

GP experts said this was further evidence that Government attempts to introduce a ‘one-size-fits-all’ approach to telemonitoring are a ‘waste of money’.

The authors of the latest analysis of the Government’s Whole System Demonstrator programme of trials looking at telehealth and telecare interventions said it showed policy-makers should not view the technology as a ‘magic bullet’.

The study, led by London School of Economics researcher Dr Catherine Henderson and published in the journal Age and Ageing, included a total of 1,189 vulnerable people with social care needs at three different sites, 550 of whom were randomised to the telecare intervention and 639 to the control care arm.

Participants in the telecare arm received various items of equipment for monitoring their functional status, such as pendants and chair occupancy sensors, for home security, including bogus caller buttons, and for their home environment, for example heat sensors.

Over 12 months there was a small – but statistically non-signficant – improvement in mean QALY score of 0.003 in the telecare compared with usual care group.

Meanwhile, costs of care, including the intervention costs, were £1,014 higher per annum for each telecare participant, resulting in a cost per additional QALY of £297,000.

This meant the probability of a decision-maker finding telecare cost effective at a willingness-to-pay threshold of £30,000 per QALY was 16%, the researchers said.

They concluded: ‘For the present, given the lack of robust evidence on cost-effectiveness in favour of telecare, policy-makers should avoid characterising this technology as a “magic bullet”.’

The study is the latest in a long line of disappointing results from the Whole Systems Demonstrator programme, and comes after Pulse revealed commissioners were struggling to implement the technology at seven pathfinder sites for the Government’s ‘3millionlives’ initiative, which aims to have three million people managed by telehealth or telecare by 2017.

NHS England announced last year it had abandoned plans to provide the telehealth and telecare to 100,000 patients in 2013 as part of 3millionlives and would be overhauling the ‘delivery model’ for the project.

Dr Grant Ingrams, deputy chair of the GPC IT subcommittee and a GP in Coventry, told Pulse the latest findings underscored the need to use telehealth and telecare in selected patients rather than adopt a ‘one-size-fits-all’ approach.

Dr Ingrams said: ‘It’s got to be done on an individual basis. We’ve done telehealth for years and that works well when you choose the patient and know they are going to be able to do it. But if you’re trying to force a one-size-fits-all approach across the whole population you end up spending loads of money where it has no benefit at all and that’s where it costs you.’

He added: ‘The problem is the politicians want something big and flashy, they want to say 90% of people with this condition are now being monitored at home. Whereas it should be 100% of patients are being monitored the best way that fits with them – whether that be at home or coming in to us or sending a nurse out – it’s got to be tailored to your individual patient or it’s a waste of money.’

A spokesperson from NHS England said: ‘There is evidence to show that when used for the patients that would benefit the most as part of the right package of care, digital technologies such as telehealth, telecare, telemonitoring and self-care apps do help to improve health outcomes and deliver cost efficiencies to the wider local health economy (e.g. by improving productivity or preventing avoidable hospital admissions).

‘NHS England is helping commissioners to see and maximise the value of technology-enabled care services to support self-care, independent living and enhance the quality of life for those with long-term conditions.’

Age and Ageing 2014; available online 20 June

Readers' comments (14)

  • £300,000 would by a few extra GPs to pamper the sick and needy....if you can find any nowadays.

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  • The perfect example of a government that wants to press on with its own agenda despite warnings from those in the know and clear evidence that the path that they are following is stupid.

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  • time for a vote of no confidence in this pathetic government

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  • 'resulting in a cost per additional QALY of £297,000.'

    Just how many millions are wasted by the DOH's inability to understand IT and costs in procurement.

    While we are trying to save pennies by being forced to swap patients to a cheaper cream to save a few pennies, while the pounds flow down the drain.

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  • I do wish doctors would stop looking at evidence and cost effectiveness with regard to clinical interventions.

    It does make it a little more difficult for government ministers to pass on lucrative contracts to friends.

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  • general practice is run by politicians for politicians' interests. it will only get worse and worse.

    There is a way out.

    Leave the NHS. Go private. Then we will be free of the scheming dishonest politicians and you can practice medicine again.

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  • GP and primary care remain the most cost effective and the best clinically validated model to provide excellent care. however, the government refuses to accept that, and is willing to throw money away to find some sort of alternative. Eventually the penny will drop, private companies offering bogus health care will not succeed.

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  • Where do we sign up then?

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  • Another example of private comapnies increasing healthcare efficiency that jeremey hunt can call on to evidence the direction of this government going into the next election!
    Reduce frontline staff to increase profit for non delivery!
    No decision about me to deliver anything to me!

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  • We tried to introduce a universal system about 15 years ago that had been demonstrated to GPs, Consultants, Local, Regional and National Managers, Nurses at all levels, Ministers and so called 'telemedicine researchers'.
    Everyone said: 'when can we have it?'
    It was to be delivered in a joint initiative with BT Health and provided a deliverable eHealth and Social Care Record with secure access levels relevant to role and position of enquiry. As a web based solution using the expertise and experience of BT (who ran NHS Net) the ability to implement a system (which had already been trialed in the USA and Florida in particular) was unquestioned.
    Having worked with Microsoft, NASA Ames Laboratory, Telecare hardware developers and many other specialist companies including our parent funders who had developed both hospital and community based pumps which could be managed remotely by the patients consultant. We had also developed a bespoke multi-parameter screening module that included ECG, SpO2, respiration, weight, core body temp etc which could be downloaded remotely or pushed by the patient if appropriate.
    Even though the professionals wanted our solution, the IT managers at the Department of Health said no. They insisted their strategy of funding a vast array of unconnected pilots was the only way forward.
    Even when I said our pricing model was based on an annual fee of £5/patient from each of the GP, Hospital/Region and Social Services budgets: the answer was still no interest - said in public by the Director of NHS IT at a conference on telemedicine.
    We could have had 15 years of integrated health and social services e-Care and telemedicine services without the ongoing costly and inefficient pilot studies - many reinventing the wheel.
    Someone really has to look at what has happened and why. So much money has been spent on systems and tools which already exist and have been in use for many years somewhere in the world.

    This link show you what the solution looked like 15 years ago! Would you have this running or prefer the pilot chaos strategy?

    John Stephenson

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