An economic evaluation of telehealth and telecare in England

Abstract

In the English health and social care system, budgets are now constrained more than ever, while an increasing proportion of the population is expected to require care. There is an urgent need to find new ways to enable people with long-term illness and disability to live well, within the national budget. Policymakers have embraced new assistive technologies such as telecare and telehealth as a means to achieve this goal. Evidence that telehealth is cost-effective is emerging but remains limited; evidence on the impacts of telecare is still more limited. In this thesis I investigate the effectiveness of two advanced assistive technologies, telehealth and telecare, in improving or maintaining health-related quality of life and other psychological outcomes, given the costs of providing these interventions. I deploy cost-effectiveness methods to analyse questionnaire data from two large-scale randomised controlled trials of telecare and telehealth in England. Drawing on provider data collected during the evaluation, I describe the inputs to production of the telehealth and telecare interventions and calculate their unit costs. I describe the health and social care costs of telehealth and telecare participants and explore participant characteristics associated with cost variations. The results of cost-effectiveness analyses of telehealth and telecare indicate that these technological interventions did not produce the hoped-for improvements in self-reported quality of life and other psychosocial outcomes, nor reduce the overall estimated annual costs of health and social care. Policymakers and practitioners would benefit from better evidence on the mechanisms by which telecare and telehealth ‘work’, and for whom, to direct future investments of resources into these technologies.