Cost-effectiveness Of Telemedicine Research Articles

Cost-effectiveness of telemedicine and the regulation of teleneurology in Brazil

Introdução: A pandemia de COVID-19 aumentou significativamente o interesse e a prática da telemedicina entre os neurologistas brasileiros. Antes dela, apenas 18,5% dos neurologistas a utilizavam, mas esse número subiu para 56,2% após seu início. A telemedicina oferece vários benefícios, como redução da taxa de não comparecimento, diminuição do tempo médio de consulta, alta satisfação de pacientes e médicos, e uma considerável redução de custos. Objetivo: Revisar a literatura sobre a custo-efetividade da telemedicina na neurologia e discutir os caminhos para sua regulamentação no sistema de saúde brasileiro. Método: Revisão integrativa para reunir e analisar evidências disponíveis sobre a teleneurologia utilizando PubMed, Medline (BVS) e Science Direct. Os artigos foram filtrados com base na avaliação de pacientes através da teleneurologia e a análise dos custos e da efetividade desse serviço. Apenas estudos originais e ensaios clínicos em inglês ou espanhol foram incluídos. Resultado: Foram incluídos 31 artigos. Conclusão: A telemedicina na neurologia é custo-efetiva e oferece várias vantagens, como redução de custos, melhoria na qualidade de vida dos pacientes e maior acesso a especialistas. A teleneurologia demonstrou ser ferramenta promissora para melhorar o atendimento em áreas rurais e remotas, onde há escassez de recursos. No entanto, a regulamentação adequada, a padronização dos protocolos clínicos e técnicos, e a sustentabilidade financeira dos programas são essenciais para a implementação bemsucedida da telemedicina. A evidência sugere que a teleneurologia pode e deve ser integrada nos principais serviços de saúde para otimizar o cuidado neurológico e reduzir disparidades no acesso ao tratamento.

Clinical and cost-effectiveness of telemedicine among patients with type 2 diabetes in primary care: A systematic review and meta-analysis.

Telemedicine has been promoted as an effective way of managing type-2 diabetes (T2DM) in primary care. However, the effectiveness of telemedicine is unclear. We investigated the clinical and cost-effectiveness of different telemedicine interventions for people with T2DM, compared to usual care. We searched Medline, Embase, Cochrane, CINHAL, ProQuest and EconLit for randomized controlled trials (RCTs) that examined the effectiveness of telemedicine interventions on clinical outcomes (HbA1c, body mass index [BMI], weight, diastolic blood pressure [DBP], systolic blood pressure [SBP], fasting blood glucose, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, total cholesterol and triglyceride) in adults with T2DM, published in English from inception until 31 December 2022. Meta-analyses were conducted using random-effects models pooling mean differences, heterogeneity was quantified using the I2 statistic. Publication bias was assessed using funnel plots, Egger tests and trim and fill. Subgroup analyses included type of telemedicine intervention, telemedicine mode of delivery and type of healthcare professionals. This study was registered with PROSPERO, CRD 42022375128. Of the 4093 records identified, 21 RCTs, 10,732 participants from seven regions, were included. Reported interventions included telephone (k = 16 studies), internet-based (k = 2), videoconference (k = 2) and telephone and emails (k = 1). We observed no statistically significant differences between synchronous or asynchronous telemedicine interventions compared to usual care for HbA1c (-0.08%(-0.88 mmol/mol); 95% CI: -0.18, 0.02), BMI (0.51 kg/m2; 95% CI: -0.21, 1.22), SBP (-1.48 mmHg; 95% CI: -3.22, 0.26), DBP (3.23 mmHg; 95% CI: -0.89, 7.34), HDL-cholesterol (0.01 mmol/L; 95% CI: -0.03, 0.05), LDL-cholesterol (0.08 mmol/L; 95% CI: -0.22, 0.37), triglycerides (-0.08 mmol/L, 95% CI: -0.31, -0.15), total cholesterol (-0.10 mmol/L; 95% CI: -0.25, 0.04) and weight (-0.50 kg; 95% CI: -1.21, 0.21). Telemedicine was as effective as usual care in improving health outcomes of people with T2DM. They can provide a safe solution in times of rising demands for primary healthcare services, or in extreme events, like a global pandemic. More high-quality RCTs are needed on the cost evaluation of telemedicine.

The Efficacy of Tele-Monitoring in Maintaining Glycated Haemoglobin Levels in Patients with Type 2 Diabetes Mellitus: A Systematic Review.

It is well documented that telemedicine offers effective accessibility and consistency which are useful in overcoming the barriers associated with the traditional delivery of chronic disease management. Furthermore, home-based telemonitoring approach for managing chronic disease conditions has been shown to break geographical barriers and facilitate provider-to-patient communication. However, the efficacy of telemedicine in reducing HbA1c is debatable. This systematic review aims to evaluate the effect of telemedicine on glycaemic control in patients with type 2 diabetes. This systematic review has been conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Searches were primarily conducted using the EBSCOhost database. Other search engines such as Cochrane Library and Google scholar were also used and search of grey literature was performed using google, NHS.uk website, WHO websites, and gov.uk website. Nine articles were included in this review. Three themes were identified in this review including diabetes education/telemonitoring technology and glycaemic control, the attitude of participants, and cost effectiveness of tele-medicine. While three studies reported improved glycaemic control with statistically significant improvement in HbA1c compared to the control group, three other studies did not find significant improvement in glycaemic control. In addition, the findings suggest that participants' positive attitude to self-care can lead to an improved HbA1c, and finally, several of the selected studies found that telemonitoring is not cost-effective. The findings of this review show that telemedicine may be effective in managing blood glucose in patients with type 2 diabetes. However, factors such as educational level of patients, attitude and costs may limit its application in primary care. More studies are required to fully establish the effectiveness of Telemonitoring in managing patients with type 2 diabetes.

Assessment of Primary Care Physicians' Perception of Telemedicine Use During the COVID-19 Pandemic in Primary Health Care Corporation, Qatar.

While telemedicine has been extensively researched throughout the globe, the Middle East has seen relatively little research on the topic. The purpose of this study was to investigate the primary care physicians' perceptions of the use of telemedicine, as well as its hurdles and benefits, during the COVID-19 pandemic in the state of Qatar. In this multicenter cross-sectional study, an internally validated questionnaire was distributed among primary care physicians utilizing telemedicine during the pandemic at Primary Health Care Corporation (PHCC), the main primary care provider in Qatar. A convenience sample was taken due to the pandemic restrictions. Out of 254 analyzed questionnaires, about half of the physicians (48%) had used telemedicine in the past primarily in the form of telephone consultations. Nearly three-quarters (74%) of physicians agreed that telemedicine is an easy way to communicate during the pandemic, but only half (52%) felt it improved job performance and effectiveness. Most physicians (90%) agreed that telemedicine is safe during the pandemic, but opinion was split on whether an optimum assessment of COVID-19 disease could be conducted. The majority also considered telemedicine an effective tool for chronic disease reviews (63%) and other consultations such as blood test results and medicine prescriptions (71%). The most significant barrier to telemedicine use was a language barrier followed by a lack of proper training. About 79% of responders felt that telemedicine improves access to healthcare and assists in contacting difficult-to-reach individuals, and 74% also thought it minimizes no-shows in the clinics. Our study has shown that most physicians felt comfortable and safer using telemedicine as an alternative means to conduct consultations during the pandemic. Keeping in view its advantages, the majority suggested that it could be incorporated into daily practice even beyond the pandemic. However, concerns were raised about its use to assess COVID-19 disease, lack of training, and potential barriers such as language differences. Further studies are needed to assess the efficiency and cost-effectiveness of telemedicine as well as the evaluation of alternative media such as video consultation, which could increase the utility of telemedicine and potentially mitigate some of its disadvantages.

Reliability of televisits for patients with mild relapsing\u2013remitting multiple sclerosis in the COVID-19 era

BackgroundEvidence of the cost-effectiveness of telemedicine (TM) for the management of Multiple Sclerosis (MS) has been provided recently. However, some doubts persist about the accuracy of neurological examinations performed remotely.ObjectivesThis study investigated the reliability of neurological evaluations performed through TM in mild MS patients as compared with standard in-person visits.MethodsIn total, 76 patients with relapsing–remitting MS and Expanded Disability Status Scale (EDSS) ≤ 3.5 were consecutively recruited. Of them, 40 patients (52.6%) accepted to undergo both in-person and TM evaluations with independent examiners within 48 h. We alternatively asked patients to assure or not the presence of a caregiver during TM visits. A satisfaction questionnaire was administered to all participants.ResultsThe inter-rater agreement attributed by two independent neurologists during TM visit was high (κ > 0.80) for EDSS and Functional Systems (FS) scores. Moderate agreement between TM and in-person evaluations emerged for pyramidal (κ = 0.57; p < 0.001), brainstem (κ = 0.57; p < 0.001), bowel and bladder (κ = 0.54; p < 0.001) and sensory (κ = 0.51; p < 0.001) FS scores, higher in patients providing the support of a caregiver. A good reliability was reported for EDSS scores computed during remote and in-person visits (ICC = 0.83; 95% CI 0.70–0.91; p < 0.001).ConclusionsDespite the complexity of neurological examination, TM could be useful in monitoring MS patients with low disability.

Cost-Effectiveness of Telemedicine in Asia: A Scoping Review.

BackgroundIn the area where there is a lack of medical experts, telemedicine gives a lot of benefits to deal with the distance and limited public infrastructure.ObjectiveThis study aimed to review the literature on the cost-effectiveness of telemedicine in Asian countries and possibly to provide recommendations on implementing telemedicine in this region.MethodsArticles were independently screened in two selected databases (PubMed and EBSCO). The framework of patient, intervention, comparison, and outcome (PICO) was applied by considering Asian population, the intervention of telemedicine, current situation (without telemedicine) as the comparator, and cost per QALY gained as the major outcome.ResultsA total of 870 articles were identified from two databases: PubMed (n = 689 articles) and EBSCO (n = 181 articles). After removing 181 duplicates, 689 articles were screened by title and abstract, excluding 665 records. After the full-text screening on 24 articles, 8 articles were selected for further analysis. Various perspectives were applied in the included studies, such as societal, healthcare, and program perspectives. All studies applied different time horizons, such as 3-month, 25-year, 40-year, and lifetime. Among all included studies, several studies applied mathematical modeling.ConclusionThe implementation of telemedicine in Asia can be a promising intervention since it can enhance the effectiveness of health services by saving time and travel costs. It also can reduce the overall costs of treatment, improve patients’ quality of life, and expand access to essential health services.

Perception of patients regarding telemedicine at times of COVID-19: Did they miss the personal touch?

260 Background: The patient-oncologist relationship is cultivated from the first clinic visit, trust and assurance established throughout the follow up period until the end of life. In March 2020, with the break of the COVID-19 pandemic, social distancing restrictions were implement throughout Israel. The adoptions of telemedicine services were incorporate as a response at our institution. Almost all ambulatory activity in the oncology division in Tel Aviv Medical Center was converted to telemedicine services. Several studies report favorable results regarding patient preference and cost effectiveness of telemedicine. Methods: We conducted a telephone interview questionnaire assessing patient satisfaction. Inclusion criteria included solid tumor patients over 18 years who utilized the telemedicine platform at Tel Aviv Sourasky Medical Center between March 2020 - May 2020. We aimed to evaluate patient's perspectives and preferences regarding telemedicine and assess whether this virtual communication affects the patient-doctor relationship. Results: Following the COVID-19 outbreak, 400 telephone calls were made to patients, 100 patients agreed to participate and surveyed. Fifty-two percent were female. The majority of patients independently downloaded the telemedicine application and did not encounter technical constraints (67%). Family members and friend attended 45% of telemedicine visits. Patients cancer diagnosis included colorectal cancer (47%), breast cancer (18%), genitourinary cancer (18%), sarcoma (9%) lung malignancies (6%), gynecological cancer (1%) and CNS tumors (2%). Visit intent included post-treatment follow up (40%), active treatment follow (53%), and first visit intake (7%). The majority of patients felt their emotional needs were met (88%) and felt that their treatment was not harmed due to absence of a physical visit (84%). Almost all patients (99%) felt their privacy was maintained. Ninety-five percent of patients affirmed that the virtual visit relieved their worries regarding treatment interruption. Importantly, 75% of patients affirmed their interest to continue telemedicine regardless of COVID-19 pandemic. Conclusions: Telemedicine is an acceptable platform that may replace follow up visits without comprising patients’ experience. Our data call for research and development of tools enabling long-term implementation of remote telemedicine and assess the patient-physician relationship and quality of care among oncology patients.

COVID-19 and telehealth: a window of opportunity and its challenges.

The rapid spread of SARS-CoV-2 has activated the world’s “emergency breaks”, forcing a slowdown of unprecedented magnitude. As a new temporary “normal” settles in, healthcare systems are making enormous efforts to adjust and mitigate the damage. These adaptation processes accelerate the use of health technologies that were on previously slow adoption paths, including telehealth. Telehealth, or telemedicine, is the use of information and communication technology to provide remote care, outside traditional healthcare contexts [1]. Disrupted healthcare systems and the need for physical distancing seem to open a window of opportunity for a broader exposure to telehealth solutions, many of which might have the potential to improve care long after the pandemic passes. As the evidence on the effectiveness, as well as cost-effectiveness of telemedicine, is mounting, harnessing its benefits post-COVID-19 will require careful consideration of arising opportunities, as well as timely, proactive action on existing challenges [1–5].

PNS45 DETERMINANTS OF THE COST-EFFECTIVENESS OF TELEMEDICINE: RESULTS FROM A SYSTEMATIC REVIEW AND MULTIVARIABLE ANALYSIS

For years, the evidence of telemedicine cost-effectiveness was scarce, explaining in part why this medical delivery remains low. We conducted a systematic review and regression analysis to determine: (1) the characteristics of telemedicine studies; (2) the determinants of economically efficient telemedicine interventions. We reviewed all published economic evaluations of telemedicine in Cochrane, Embase and Pubmed from 2008 to 2018. Articles were classified by two researchers (protocol available on PROSPERO). We constructed an exclusive dataset on the characteristics of selected articles, including: type of telemedicine intervention; medical field; indicators of the quality of the trial. The dataset was enriched using OECD data on medical density and socio-demographic controls at the country level. We explained the determinants of economically dominant telemedicine interventions using a multivariable logit model and estimated effects using odd-ratios. We included 151 articles out of 2488 (acceptation rate: 6.1%). Most economic studies of our sample regard telemonitoring (67.5%), followed by teleconsultation (19.1%), teleassistance (10.8%) and tele-expertise (2.7%). Overall, they follow recommended guidelines: 85.3% are cost-effectiveness or cost-utility analysis, the median number of participants is 229, and 75.8% are randomised. 17.2% of included trials regard mental health interventions. 72.6% of these studies found that the telemedicine intervention dominated economically the control group. All things equal, cost-effectiveness of telemedicine is significantly negatively associated with medical density, and indicators of quality. We found no significant effect of the publication year, signifying that the nature of the evidence has not changed overtime. In summary, articles with higher standards of economic evaluation are less likely to report a dominant intervention. However, published evidence has found that telemedicine is overall cost-effective, regardless of the medical field. The number of economic evaluations on telemedicine has grown significantly over the reviewed period. This should benefit public decision and increase recourse to telemedicine.

Custo-efetividade da telemedicina no acompanhamento de asmáticos: revisão sistemática

Aim: systematic review of the literature on the cost-effectiveness of telemedicine in the follow-up of asthmatics. Method: Systematic review of the PUBMED / MEDLINE, LILACS and Cochrane Central databases. Articles published in English, Portuguese or Spanish were considered in the period from 2005 to 2018 according to the PRISMA guidelines. Results: A total of 1363 articles were identified, of which 59 were read in their entirety. Only five met the eligibility criteria, and all were made in European countries and totaled 2,497 participants. The interventions were performed by nurses (4 of 5 studies), remaining from 16 weeks to 12 months. Telemedicine costs were similar or slightly lower compared to usual treatments. Telemedicine had a beneficial effect on asthma control (1 of 5 studies), quality of life (3 out of 5 studies) and hospitalizations (1 of 5 studies). Conclusion: Telemedicine slightly reduces costs with asthma management and may have an impact on morbidity indicators

Cost-Effectiveness of Telemedicine in Remote Orthopedic Consultations: Randomized Controlled Trial.

BackgroundTelemedicine consultations using real-time videoconferencing has the potential to improve access and quality of care, avoid patient travels, and reduce health care costs.ObjectiveThe aim of this study was to examine the cost-effectiveness of an orthopedic videoconferencing service between the University Hospital of North Norway and a regional medical center in a remote community located 148 km away.MethodsAn economic evaluation based on a randomized controlled trial of 389 patients (559 consultations) referred to the hospital for an orthopedic outpatient consultation was conducted. The intervention group (199 patients) was randomized to receive video-assisted remote orthopedic consultations (302 consultations), while the control group (190 patients) received standard care in outpatient consultation at the hospital (257 consultations). A societal perspective was adopted for calculating costs. Health outcomes were measured as quality-adjusted life years (QALYs) gained. Resource use and health outcomes were collected alongside the trial at baseline and at 12 months follow-up using questionnaires, patient charts, and consultation records. These were valued using externally collected data on unit costs and QALY weights. An extended sensitivity analysis was conducted to address the robustness of the results.ResultsThis study showed that using videoconferencing for orthopedic consultations in the remote clinic costs less than standard outpatient consultations at the specialist hospital, as long as the total number of patient consultations exceeds 151 per year. For a total workload of 300 consultations per year, the annual cost savings amounted to €18,616. If costs were calculated from a health sector perspective, rather than a societal perspective, the number of consultations needed to break even was 183.ConclusionsThis study showed that providing video-assisted orthopedic consultations to a remote clinic in Northern Norway, rather than having patients travel to the specialist hospital for consultations, is cost-effective from both a societal and health sector perspective. This conclusion holds as long as the activity exceeds 151 and 183 patient consultations per year, respectively.Trial RegistrationClinicalTrials.gov NCT00616837; https://clinicaltrials.gov/ct2/show/NCT00616837 (Archived by WebCite at http://www.webcitation.org/762dZPoKX)

Mobile Health (m-health) and Electronic Health (e-health) Services: A Study in Cost-Effectiveness of Telemedicine, Electronic, and Mobile Health Systems

Mobile Health (m-health) and Electronic Health (e-health) Services: A Study in Cost-Effectiveness of Telemedicine, Electronic, and Mobile Health Systems

Telemedicine in heart failure-more than nice to have?

Telemedicine in chronic diseases like heart failure is rapidly evolving and has two important goals: improving and individualising care as well as reducing costs. In this paper, we provide a critical and an updated review of the current evidence by discussing the most important trials, meta-analyses and systematic reviews. So far, evidence for the CardioMEMS device is most convincing. Other trials regarding invasive and non-invasive telemonitoring and telephone support show divergent results, but several meta-analyses and systematic reviews uniformly reported a beneficial effect. Voice-over systems and ECG monitoring had neutral results. Lack of direct comparison between different modalities makes it impossible to determine the most effective method. Dutch studies showed predominantly non-significant results, mainly due to underpowered studies or because of a high standard of usual care. There are no conclusive results on cost-effectiveness of telemedicine because of the above shortcomings. The adherence of elderly patients was good in the trials, being essential for the compliance of telemedicine in the entire heart failure population. In the future perspective, telemedicine should be better standardised and evolve to be more than an addition to standard care to improve care and reduce costs.

The Economic Burden of Heart Conditions in Brazil.

BackgroundHeart conditions impose physical, social, financial and health-related quality of life limitations on individuals in Brazil.ObjectivesThis study assessed the economic burden of four main heart conditions in Brazil: hypertension, heart failure, myocardial infarction, and atrial fibrillation. In addition, the cost-effectiveness of telemedicine and structured telephone support for the management of heart failure was assessed.MethodsA standard cost of illness framework was used to assess the costs associated with the four conditions in 2015. The analysis assessed the prevalence of the four conditions and, in the case of myocardial infarction, also its incidence. It further assessed the conditions’ associated expenditures on healthcare treatment, productivity losses from reduced employment, costs of providing formal and informal care, and lost wellbeing. The analysis was informed by a targeted literature review, data scan and modelling. All inputs and methods were validated by consulting 15 clinicians and other stakeholders in Brazil. The cost-effectiveness analysis was based on a meta-analysis and economic evaluation of post-discharge programs in patients with heart failure, assessed from the perspective of the Brazilian Unified Healthcare System (Sistema Unico de Saude).ResultsMyocardial infarction imposes the greatest financial cost (22.4 billion reais/6.9 billion USD), followed by heart failure (22.1 billion reais/6.8 billion USD), hypertension (8 billion reais/2.5 billion USD) and, finally, atrial fibrillation (3.9 billion reais/1.2 billion USD). Telemedicine and structured telephone support are cost-effective interventions for achieving improvements in the management of heart failure.ConclusionsHeart conditions impose substantial loss of wellbeing and financial costs in Brazil and should be a public health priority.

The Economic Burden of Heart Conditions in Brazil

Background: Heart conditions impose physical, social, financial and health-related quality of life limitations on individuals in Brazil. Objectives: This study assessed the economic burden of four main heart conditions in Brazil: hypertension, heart failure, myocardial infarction, and atrial fibrillation. In addition, the cost-effectiveness of telemedicine and structured telephone support for the management of heart failure was assessed. Methods: A standard cost of illness framework was used to assess the costs associated with the four conditions in 2015. The analysis assessed the prevalence of the four conditions and, in the case of myocardial infarction, also its incidence. It further assessed the conditions’ associated expenditures on healthcare treatment, productivity losses from reduced employment, costs of providing formal and informal care, and lost wellbeing. The analysis was informed by a targeted literature review, data scan and modelling. All inputs and methods were validated by consulting 15 clinicians and other stakeholders in Brazil. The cost-effectiveness analysis was based on a meta-analysis and economic evaluation of post-discharge programs in patients with heart failure, assessed from the perspective of the Brazilian Unified Healthcare System (Sistema Unico de Saude). Results: Myocardial infarction imposes the greatest financial cost (22.4 billion reais/6.9 billion USD), followed by heart failure (22.1 billion reais/6.8 billion USD), hypertension (8 billion reais/2.5 billion USD) and, finally, atrial fibrillation (3.9 billion reais/1.2 billion USD). Telemedicine and structured telephone support are cost-effective interventions for achieving improvements in the management of heart failure. Conclusions: Heart conditions impose substantial loss of wellbeing and financial costs in Brazil and should be a public health priority.

PCV68 - The Economic Burden of Four Heart Conditions in Brazil

The economic burden of heart conditions in Brazil has not been previously quantified. This study assessed the economic burden of heart failure (HF), myocardial infarction (MI), atrial fibrillation (AF), and hypertension (HTN) in Brazil, and the cost effectiveness (CE) of telemedicine (TM) and structured telephone support (STS) for the treatment of HF. To estimate the cost of four heart conditions by country, a prevalence approach was used for HF, AF and HTN, and an incidence approach was used for MI. Costs were estimated for the year 2015 and included health system expenditures, productivity losses (absenteeism, lower workforce participation, premature mortality) and informal care costs, and deadweight losses associated with government expenditures. Data inputs for costs, including prevalence and incidence, were based on secondary data sources informed by a targeted literature review including country specific grey literature and data bases. The study also appraised the value of the loss of healthy life, measured in disability adjusted life years (DALYs), using global burden of disease disability weights. All inputs were triangulated using semi-structured interviews with clinicians, insurers and health administrators. The CE of TM and STS relative to usual care was assessed using a Markov model consisting of two permanent and two temporary health states. Accounting for co-morbidities, the conditions affected approximately 45.7 million people (32% of the adult population) in Brazil in 2015 leading to significant wellbeing loss, estimated at 3.2 million DALYs, and economic burden, estimated at BRL56.2 billion in 2015. The CE analysis suggested that TM and STS may both be cost effective treatment options for the management of patients with HF. Heart conditions impose a significant burden to the health system and society; their prevention and appropriate management would result in substantial wellbeing benefits and economic savings.

PCV63 - The Economic Burden of Four Heart Conditions in Mexico

The economic burden of heart conditions in Mexico has not been previously quantified. This research assessed the economic burden of heart failure (HF), myocardial infarction (MI), atrial fibrillation (AF), and hypertension (HTN) in Mexico, and the cost effectiveness (CE) of telemedicine (TM) and structured telephone support (STS) for the treatment of HF. To estimate the cost of four heart conditions by country, a prevalence approach was used for HF, AF and HTN, and an incidence approach was used for MI. Costs were estimated for the year 2015 and included health system expenditures, productivity losses (absenteeism, lower workforce participation, premature mortality) and informal care costs, and deadweight losses associated with government expenditures. Data inputs for costs, including prevalence and incidence, were based on secondary data sources informed by a targeted literature review including country specific grey literature and data bases. The study also appraised the value of the loss of healthy life, measured in disability adjusted life years (DALYs), using global burden of disease disability weights. All inputs were triangulated using semi-structured interviews with clinicians, insurers and health administrators. The CE of TM and STS relative to usual care was assessed using a Markov model consisting of two permanent and two temporary health states. Accounting for co-morbidities, the conditions affected approximately 20.5 million people (25.6% of the adult population) in Mexico in 2015 leading to significant wellbeing loss, estimated at 1.6 million DALYs, and economic burden, estimated at MXN96.4 billion in 2015. TM and STS were found to be cost effective treatment options for the management of HF. Heart conditions impose a significant burden to the health system and society; their prevention and appropriate management would result in substantial wellbeing benefits and economic savings. TM and STS are cost effective mechanisms for achieving improvements in HF management.

PCV67 - The Economic Burden of Four Heart Conditions in Latin America

The economic burden of heart conditions in the Latin American region has not been previously quantified. This study assessed the economic burden of heart failure (HF), myocardial infarction (MI), atrial fibrillation (AF), and hypertension (HTN) in Brazil, Chile, Colombia, Ecuador, El Salvador, Mexico, Panama, Peru, Venezuela, and the cost effectiveness (CE) of structured telephone support (STS) and telemedicine (TM) for the treatment of HF. To estimate the cost of four heart conditions by country, a prevalence approach was used for HF, AF and HTN, and an incidence approach was used for MI. Costs were estimated for the year 2015 and included health system expenditures, productivity losses (absenteeism, lower workforce participation, premature mortality) and informal care costs, and deadweight losses associated with government expenditures. Data inputs for costs, including prevalence and incidence, were based on secondary data sources informed by a targeted literature review including country specific grey literature and data bases. The study also appraised the value of the loss of healthy life, measured in disability adjusted life years (DALYs), using global burden of disease disability weights. All inputs were triangulated using semi-structured interviews with clinicians, insurers and health administrators. The CE of TM and STS vs. usual care was assessed using a Markov model consisting of two permanent and two temporary health states. Accounting for co-morbidities, the conditions affected approximately 89.6 million people (28% of the adult population) in the nine countries in 2015 leading to significant wellbeing loss of 7.0 million DALYs, and economic burden of USD 31.1 billion in 2015. The CE analysis suggested TM and STS may be cost effective treatment options for the management of HF. Heart conditions impose a significant burden to health systems and society; their prevention and appropriate management would result in substantial wellbeing benefits and economic savings

The reported benefits of telehealth for rural Australians

A literature review was conducted to identify the reported benefits attributed to telehealth for people living and professionals working in rural and remote areas of Australia. Scopus and relevant journals and websites were searched using the terms: telemedicine, telehealth, telepsychiatry, teledermatology, teleradiology, Australia, and each state and territory. Publications since 1998 were included. The initial search resulted in 176 articles, which was reduced to 143 when research reporting on Australian rural, regional or remote populations was selected. A narrative review was conducted using an existing 'benefits' framework. Patients are reported to have benefited from: lower costs and reduced inconvenience while accessing specialist health services; improved access to services and improved quality of clinical services. Health professionals are reported to have benefits from access to continuing education and professional development; provision of enhanced local services; experiential learning, networking and collaboration. Rural Australians have reportedly benefited from telehealth. The reported improved access and quality of clinical care available to rural Australians through telemedicine and telehealth may contribute to decreasing the urban-rural health disparities. The reported professional development opportunities and support from specialist through the use of telehealth may contribute to improved rural medical workforces recruitment and retention.

Database-Supported Teleconferencing: An Additional Clinical Mentoring Tool to Assist a Multinational Company HIV/AIDS Treatment Program in Africa

Background: The lack of human resources for health is presently recognized as a major factor limiting scale-up of antiretroviral treatment (ART) programs in resourcelimited settings. The mobilization of public and private partners, the decentralization of care, and the training of non-HIV specialist nurses and general practitioners could help increase the number of HIV-infected patients receiving ART. In addition to other forms of training, scheduled teleconferences (TCs) have been organized to support a comprehensive HIV treatment program delivered by a private company’s health team. Objective: To describe the role of the TC as an additional tool in mentoring a company’s health care workers (HCWs). Method: For this study, all TC reports were retrospectively reviewed and the questions classified by topic. Participating Heineken physicians evaluated the technical quality and scientific relevance of the TCs through an anonymous survey. Results: From October 2001 to December 2003, 10 HCWs working in 14 operating companies in 5 African countries raised 268 problems during 45 TCs. A total of 79 questions (29%) were asked about antiretroviral (ARV) therapy, 53 (20%) about the diagnosis and treatment of opportunistic infection, 43 (16%) about ARV toxicity, 40 (15%) about care organization and policy, 32 (12%) about laboratory or drug supply, and 21 (8%) about biological parameters. The mean TC attendance rate was 70%. The level of satisfaction among local company physicians was 65% for logistics, 89% for scientific relevance, 84% for applicability of advice, and 85% overall. The most common complaints concerned the poor quality of the telephone connection and language problems for francophone participants. Conclusion: Database-supported teleconferencing could be an additional tool to mentor company HCWs in their routine care of HIV-infected workers and family members. The role and costeffectiveness of telemedicine in improving health outcomes should be further studied.