Study questions cost-effectiveness of telemedicine

One of the first studies to examine the economic benefits of teleradiology and telemedicine has failed to find good evidence that these solutions are a cost-effective means of delivering healthcare.

The study reported in BMJ (2002;324:1434-1437) followed a comprehensive literature search of cost-related articles on telemedicine. It identified 612 such English language, peer-reviewed journal articles, but only 57 (9%) contained any cost benefit data.

"Of these 57, only 24 stood up to a full review using an established instrument for assessing the quality of economic evaluations," said lead author Pamela S. Whitten, Ph.D., an associate professor of telecommunications at Michigan State University.

Most of the studies analyzed were small scale, short-term, pragmatic evaluations that added little to our knowledge of the costs and benefits expected from the introduction of telemedicine services into routine clinical practice, she said.

The potential economic benefits of teleradiology and telemedicine have been touted by proponents. In rural settings in the U.S., telemedicine systems have been used principally as a means of easing the problem of obtaining specialist advice and making referrals over wide distances. In Britain, telemedicine systems have been proposed as a cost-effective means of responding to structural problems in the organization of the National Health Service, Whitten said.

"Even so, major questions about the cost-effectiveness of telemedicine systems remain because the data used to support such claims are dispersed across studies of widely differing systems and diverse organizational contexts," she said.

Reported studies are often not only small in scale, according to Whitten. They are methodologically flawed and reflect pragmatic evaluations rather than controlled trials, making them unsuitable for formal meta-analysis.

The conventional response to such news, she said, is to emphasize the need for better designed and conducted trials, and these are certainly necessary.

"However, focusing on deficiencies in the design and conduct of research should not divert our attention from the other deficiencies revealed by this review," Whitten said.

Peer review also seems to have failed to address adequately the range of basic errors in design and analysis that littered the studies reviewed.

"Interested clinicians, policy makers, and healthcare providers should not assume that peer reviewed publication is necessarily an adequate guarantee of quality for economic evaluations of telemedicine," Whitten said.