**5.3 Cost-effectiveness**

Analysis of cost-effectiveness of telehealth requires study of the impact on use of all the health services by patients. This normally focusses on hospital services, such

**Figure 25.** *Cost–benefit analysis.*

**Figure 26.** *Use of the QALY to assess cost benefit.*

as admission, emergency room visits, and length of stay, as these contribute most. This is balanced by the incremental cost of the technology and staffing costs to provide the service. A cost model may then be created to evaluate. However few well defined studies exist. The review in [39] provides a meta-analysis of the impact on hospital services for patients with CHF; however none of the studies provided outcomes for cost-effectiveness.

#### *5.3.1 All cause and CHF hospital admission*

The same review [39] found six studies that reported all cause hospital admissions as primary outcome (**Figure 27**). None reported significant reduction and the pooled estimates support this (0.99, 0.88 to 1.11, P = 0.84).

In contrast, some reduction in CHF hospital admission was reported by the same set of studies (**Figure 28**). Pooled estimates of the given data indicate that there is a small reduction that is significantly relevant (0.73, 0.62 to 0.87, P = 0.0004). Bias was unlikely but possibility of heterogeneity could not be ruled out in all cause hospital admission (P = 0.03, I<sup>2</sup> = 59%). There was little evidence of heterogeneity for CHF (P = 0.44, I<sup>2</sup> = 0%).

#### **Figure 27.**

*Effect of telemonitoring on all-cause hospital admission [39].*
