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      Cost-Utility and Cost-Effectiveness Studies of Telemedicine, Electronic, and Mobile Health Systems in the Literature: A Systematic Review

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          Abstract

          A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the literature is presented.

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          Most cited references32

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          Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis.

          The decisions made by the National Institute for Clinical Excellence (NICE) give rise to two questions: how is cost-effectiveness evidence used to make judgements about the 'value for money' of health technologies? And how are factors other than cost-effectiveness taken into account? The aim of this paper is to explore NICE's cost-effectiveness threshold(s) and the tradeoffs between cost effectiveness and other factors apparent in its decisions. Binary choice analysis is used to reveal the preferences of NICE and to consider the consistency of its decisions. For each decision to accept or reject a technology, explanatory variables include: the cost per life year or per QALY gained; uncertainty regarding cost effectiveness; the net cost to the NHS; the burden of disease; the availability (or not) of alternative treatments; and specific factors indicated by NICE. Results support the broad notion of a threshold, where the probability of rejection increases as the cost per QALY increases. Cost effectiveness, together with uncertainty and the burden of disease, explain NICE decisions better than cost effectiveness alone. The results suggest a threshold somewhat higher than NICEs stated 'range of acceptable cost effectiveness' of pound 20,000-30,000 British pounds per QALY--although the exact meaning of a 'range' in this context remains unclear. Copyright 2004 John Wiley & Sons, Ltd.
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            Systematic review of cost effectiveness studies of telemedicine interventions.

            To systematically review cost benefit studies of telemedicine. Systematic review of English language, peer reviewed journal articles. Searches of Medline, Embase, ISI citation indexes, and database of Telemedicine Information Exchange. STUDIES SELECTED: 55 of 612 identified articles that presented actual cost benefit data. Scientific quality of reports assessed by use of an established instrument for adjudicating on the quality of economic analyses. 557 articles without cost data categorised by topic. 55 articles with data initially categorised by cost variables employed in the study and conclusions. Only 24/55 (44%) studies met quality criteria justifying inclusion in a quality review. 20/24 (83%) restricted to simple cost comparisons. No study used cost utility analysis, the conventional means of establishing the "value for money" that a therapeutic intervention represents. Only 7/24 (29%) studies attempted to explore the level of utilisation that would be needed for telemedicine services to compare favourably with traditionally organised health care. None addressed this question in sufficient detail to adequately answer it. 15/24 (62.5%) of articles reviewed here provided no details of sensitivity analysis, a method all economic analyses should incorporate. There is no good evidence that telemedicine is a cost effective means of delivering health care.
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              Bias in published cost effectiveness studies: systematic review.

              To investigate if published studies tend to report favourable cost effectiveness ratios (below 20,000 dollars, 50,000 dollars, and 100,000 dollars per quality adjusted life year (QALY) gained) and evaluate study characteristics associated with this phenomenon. Systematic review. Studies reviewed 494 English language studies measuring health effects in QALYs published up to December 2001 identified using Medline, HealthSTAR, CancerLit, Current Content, and EconLit databases. Incremental cost effectiveness ratios measured in dollars set to the year of publication. Approximately half the reported incremental cost effectiveness ratios (712 of 1433) were below 20,000 dollars/QALY. Studies funded by industry were more likely to report cost effectiveness ratios below 20,000 dollars/QALY (adjusted odds ratio 2.1, 95% confidence interval 1.3 to 3.3), 50,000 dollars/QALY (3.2, 1.8 to 5.7), and 100,000 dollars/QALY (3.3, 1.6 to 6.8). Studies of higher methodological quality (adjusted odds ratio 0.58, 0.37 to 0.91) and those conducted in Europe (0.59, 0.33 to 1.1) and the United States (0.44, 0.26 to 0.76) rather than elsewhere were less likely to report ratios below 20,000 dollars/QALY. Most published analyses report favourable incremental cost effectiveness ratios. Studies funded by industry were more likely to report ratios below the three thresholds. Studies of higher methodological quality and those conducted in Europe and the US rather than elsewhere were less likely to report ratios below 20,000 dollars/QALY.
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                Author and article information

                Journal
                Telemedicine and e-Health
                Telemedicine and e-Health
                Mary Ann Liebert Inc
                1530-5627
                1556-3669
                February 2015
                February 2015
                : 21
                : 2
                : 81-85
                Affiliations
                [1 ]Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Valladolid, Spain.
                [2 ]Department of Informatics, University of Valladolid, Valladolid, Spain.
                [3 ]Department of Statistics, University of Valladolid, Valladolid, Spain.
                [4 ]Department of Informatics and Numeric Analysis, University of Cordoba, Cordoba, Spain.
                Article
                10.1089/tmj.2014.0053
                4312789
                25474190
                2008848d-d33e-44de-82d2-51b3dae2e5c0
                © 2015

                https://www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/

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