As 'telehealth' grows, experts question cost benefits

* Better patient targeting, economies of scale might help

* Telehealth viewed by IT, telecoms firms as big opportunity

By Ben Hirschler

LONDON, March 22 Monitoring patients at home using modern technology, so-called 'telehealth', is tipped as the next big thing in healthcare, but a new study by British researchers suggests it may not be worth the extra expense.

The findings will fuel controversy over the economic case for telehealth, which many information technology and telecoms companies are betting on as a multibillion-dollar market opportunity.

Martin Knapp, professor of social policy at the London School of Economics, one of the leaders of the study, said the disappointing results did not mean telehealth was a waste of time but did suggest it needed to be better targeted.

In some cases, smarter technology and a scaling up of programmes might help improve the outcome, he added.

"We have got to find ways of better adjusting the equipment to suit the circumstances of the individual patient," he said in an interview. "Just at the moment we don't find the advantage that people had hoped for."

Knapp and colleagues tested the cost-effectiveness of telehealth compared with standard care over 12 months in 965 patients with three long-term conditions: heart failure, chronic obstructive pulmonary disease or diabetes.

Just over half the patients received equipment to allow them to measure things like blood pressure and blood glucose levels at home. They then transmitted their readings electronically to a healthcare professional.

The pay-off, however, was marginal. The researchers found that the cost per quality adjusted life year (QALY) - a standard measure of quantity and quality of life - of telehealth when added to usual care was 92,000 pounds ($139,200).

That is well above the 30,000 pounds that Britain's National Institute for Health and Clinical Excellence (NICE) uses as a benchmark for assessing if medical interventions are worth using on the state-run health service.

"Telehealth does not seem to be a cost effective addition to standard support and treatment," the study authors concluded in their report in the British Medical Journal on Friday.

The study used data from the Whole System Demonstrator programme, a wide-ranging assessment of telehealth backed by the British government that has already triggered controversy.

British health minister Jeremy Hunt cited encouraging results from the programme last November when he announced plans to roll out telehealth to 100,000 people with long-term conditions in 2013 and have 3 million on the system by 2017.

Hunt's plan will make Britain second only to the United States as an adopter of technology to monitor patients at home and the UK department of health has claimed it could save up to 1.2 billion pounds over five years.

But several medical experts have questioned whether the programme really shows that telehealth improves quality of life and Knapp said the savings being forecast were "optimistic".

Many companies, from medical equipment firms to developers of smartphone apps, are already vying for a piece of a market that has been talked about for 20 years but is now finally gaining traction.

According to PricewaterhouseCoopers the worldwide market for mobile communications and devices used in healthcare will reach about $23 billion by 2017, up from $4.5 billion forecast for 2013. Telecom network operators will be the biggest winners, grabbing roughly half of those sales, which explains the growing focus of companies like Telefonica on healthcare.

The balance will be shared by a raft of other players, such as General Electric, Microsoft, Cisco, Intel, Philips and Siemens.