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The Whole Systems Demonstrator pilot – a summary of the evidence so far

A round-up of the published results from the trial to date.

June 2012: Telehealth reduces mortality and hospital admissions – but costs uncertain

BMJ 2012; 344: e3874

Headline results from the telehealth arm of WSD practice-level randomised trial. Included 3,230 patients with diabetes, COPD, or heart failure, from 179 practices and involved range of technologies and protocols for monitoring as well as educational messages.

Telehealth resulted in a significant 45% reduction in mortality and 20% reduction in hospital admissions at 12 months, compared with usual care.

However, reduction in overall hospital costs (including emergency admissions, elective admissions and outpatient visits) associated with telehealth -  £188 per patient - was not statistically significant, leading researchers to conclude that a cost reduction ‘cannot be assumed’.

 

Feb 2013: Telecare fails to reduce admissions or costs

Age Ageing 2013; online 25 February

Included 2,600 people with social care needs, from 217 practices, who were monitored remotely with telecare using a pendant alarm and up to 27 devices, covering falls detectors and other types of functional sensors, security (eg bogus calls) and environmental monitors (eg monoxide detectors), as well as standalone devices for daily living support.

Over the 12-month follow-up, telecare made no difference to the primary outcome of hospital admission, with 46.8% of telecare patients versus 49.2% of usual care patients admitted – a non-significant difference. Telecare also failed to impact on length of hospital stays, admissions to residential/nursing care, GP contacts, or hospital and social care costs.

 

Feb 2013: Telehealth fails to improve quality of life or psychological wellbeing

BMJ 2013; 346: f653

Analysis of patient reported outcomes for the 3,230 patients receiving telehealth monitoring for diabetes, COPD, or heart failure.

Revealed no significant differences between telehealth and usual care groups in patients’ generic or health-related quality of life,  anxiety or depressive symptoms, at either 4 or 12 months.

However, telehealth had no adverse impact on these outcomes.

 

March 2013: Telehealth not cost-effective

BMJ 2013; 346: f1035

Cost-effectiveness analysis in 965 patients from telehealth arm of trial, 534 of whom received telehealth and 431 standard care.

Total service costs (including direct costs of the intervention) were higher in the telehealth group (£1,596) than the usual care group (£1,390) in three months preceding the 12-month follow-up.

Intervention cost high at £92,000 per QALY gained.

Probability of cost-effectiveness was 11% at willingness-to-pay threshold of £30,000 and only reached 50% at threshold of £90,000.

Modelling based on substantially reduced costs and improved efficiency of intervention still only showed probability of cost-effectiveness of 61%.

 

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