Cost-effectiveness of telemedicine versus standard care for the management of diabetes mellitus, hypertension and heart failure: meta-analysis of randomized trials. (Preprint)

<sec> <title>BACKGROUND</title> The effectiveness of telemedicine strategies for the efficient management of chronic diseases has been evaluated by a number of studies, and the most recent umbrella review of meta-analyses on the topic concluded that there is sufficient evidence supporting the use of telehealth for patients with diabetes, hypertension, or heart failure. However, in-depth assessments of the cost-effectiveness of telemedicine are severely lacking. </sec> <sec> <title>OBJECTIVE</title> This meta-analysis aimed at estimating the Incremental Cost Effectiveness Ratios (ICER) of telemedicine for the management of type II diabetes mellitus, hypertension, and heart failure. </sec> <sec> <title>METHODS</title> We searched multiple databases for all randomized or quasi-randomized trials (RCTs), which evaluated the cost-effectiveness of telemedicine versus standard care for managing the selected diseases. The outcomes were the ICER per Quality-Adjusted Life Year (QALY), 1 mmHg reduction of systolic blood pressure (SBP), or 1% reduction of glycated hemoglobin (HbA1c), after 12 months of follow-up. Random-effect meta-analyses were run when sufficient data were provided, and weighted ICER means were computed. </sec> <sec> <title>RESULTS</title> A total of 22 trials were included in the systematic review (10,978 patients): ten on hypertension, all using telemonitoring, six on hearth failure, and six on diabetes, mostly using telephone support. Meta-analyses were possible for two outcomes only, as most trials did not report a measure of dispersion: (1) the summary estimate of ICER per QALY, based upon four trials (1974 patients), was $42,623 (while the weighted mean, based upon 5 trials, was $29,477); (2) the summary estimate of ICER per 1mmHg SBP reduction, based on five studies, was $27 (while the weighted mean was $132, based upon 9 trials). The weighted means of ICER per QALY for hypertension and diabetes were $22,769 and $40,503, respectively. Finally, the weighted mean of ICER per 1% HbA1c reduction was $3546. Some of the estimates were substantially lower when only recent trials were considered. </sec> <sec> <title>CONCLUSIONS</title> The results support employing telemedicine as a cost-effective strategy to monitor hypertension, heart failure and, depending on the willingness to pay, diabetes. Further RCTs reporting confidence intervals for ICER are required to confirm these findings. </sec>