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Telehealth cuts hospital admissions, but not costs

The Government's flagship project to boost commissioning of telehealth projects across the country will reduce hospital admissions, but is unlikely to have a significant impact on costs, an official evaluation reveals.

Findings from the Whole System Demonstrator cluster randomised trial show that for people with long term conditions, telehealth can reduce mortality and help avoid emergency hospital care.

But the estimated scale of hospital cost savings need to be ‘tempered' by the cost of the technology, concludes the full evaluation published in the BMJ today.

An accompanying editorial adds that the results do not convincingly support the ‘3millionlives' project - the DH's scheme to bring telehealth and telecare to three million people with long term conditions and complex care needs.

The Whole System Demonstrator study is one of the largest telehealth studies ever conducted and involved 1,570 patients who were given devices and taught how to monitor their condition at home and transmit the data to health care professionals. A further 1,584 control patients received usual care.

During the study period, significantly fewer - 43% - of intervention patients were admitted to hospital compared with 48% of control patients. Significantly fewer - 5% - of intervention patients died compared with 8% of controls. This equated to about 60 lives over a 12-month period.

There was a £188 per patient reduction in hospital costs between cases and controls, but this was not statistically significant and did not include the costs of the telehealth equipment needed.

Pulse revealed earlier this year that telehealth pilot schemes in two areas of the country were suffering from low take-up, and that investigators estimated there was less than a 40% chance of it being cost-effective.

In the final analysis of the trial, the researchers raised doubts whether the benefits of telehealth would be offset by the cost of the technology.

They concluded: ‘Although the observed difference in emergency admissions associated with the intervention indicates some potential to reduce use of secondary care, the findings need to be tempered by the estimated scale of the difference in notional hospital cost savings and the cost of the intervention.'

In an accompanying editorial, Dr Josip Carr, director of the Global eHealth Unit at Imperial College London, said more research was needed before the programme was rolled out further.

 He said: ‘Does the demonstrator trial provide convincing evidence for commissioning a national roll-out of telehealth? The findings reported to date suggest not, although we recommend caution until the full data are released. There is great potential but also still much to be done.'

Care services minister Paul Burstow claimed the study supported the DH drive to use telehealth and telecare: ‘We are working closely with industry, the NHS and social care organisations to make progress through the 3millionlives initiative to develop flexible funding models with a reduced price point, which will achieve the economies of scale needed to make telehealth a success.'

 But Dr Grant Ingrams, a GP in Coventry, said use of telehealth should be targeted rather than rolled out across the board: ‘It should be evolution rather than revolution. Revolution is where you run into trouble.'

BMJ 2012;344:e3874