Telemedicine, Outcomes and Policy Decisions

Abstract

The rapid increase in telemedicine technologies has increased the demand for assessment studies to inform decision makers as to how feasible, efficient, effective, cost effective and/or cost saving the new technology is compared with a conventional alternative. In this article, we considered the main methods used for health technology assessment studies in the field of telemedicine, the types of outcome that are evaluated, and the application of the general assessment framework to the field of telemedicine. Studies of telemedicine may consider technical outcomes, feasibility of applications, surrogate or actual clinical measures, health-related quality of life (HR-QOL), and economic issues. To date, only a few studies have measured clinical outcomes or HR-QOL to show the outcomes of telemedicine compared with a conventional alternative. In economic analyses of telemedicine, many studies are simply cost descriptions, that is, costs of the telemedicine alternative are shown. For decision-making purposes cost-effectiveness and cost-benefit analyses would provide much better information. The differences in healthcare systems between countries as well as the differences in costs and reimbursement methods make the decision-making process challenging. To reduce the burden in the decision-making process, it is recommended that the local conditions influencing results should be presented in studies. Sensitivity analysis can be used to show the changes in the results when the background variables in the decision-making process are changed.