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Cost-effectiveness of telehealthcare to patients with chronic obstructive pulmonary disease: results from the Danish ‘TeleCare North’ cluster-randomised trial
  1. Flemming Witt Udsen1,
  2. Pernille Heyckendorff Lilholt2,
  3. Ole Hejlesen2,
  4. Lars Ehlers1
  1. 1 Danish Centre for Healthcare Improvements, Aalborg University, Aalborg, Denmark
  2. 2 Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
  1. Correspondence to Dr Flemming Witt Udsen; fwu{at}business.aau.dk

Abstract

Objectives To investigate the cost-effectiveness of a telehealthcare solution in addition to usual care compared with usual care.

Design A 12-month cost-utility analysis conducted alongside a cluster-randomised trial.

Setting Community-based setting in the geographical area of North Denmark Region in Denmark.

Participants 26 municipality districts define randomisation clusters with 13 districts in each arm. 1225 patients with chronic obstructive pulmonary disease were enrolled, of which 578 patients were randomised to telehealthcare and 647 to usual care.

Interventions In addition to usual care, patients in the intervention group received a set of telehealthcare equipment and were monitored by a municipality-based healthcare team. Patients in the control group received usual care.

Main outcome measure Incremental costs per quality-adjusted life-years gained from baseline up to 12 months follow-up.

Results From a healthcare and social sector perspective, the adjusted mean difference in total costs between telehealthcare and usual care was €728 (95% CI −754 to 2211) and the adjusted mean difference in quality-adjusted life-years gained was 0.0132 (95% CI −0.0083 to 0.0346). The incremental cost-effectiveness ratio was €55 327 per quality-adjusted life-year gained. Decision-makers should be willing to pay more than €55 000 to achieve a probability of cost-effectiveness >50%. This conclusion is robust to changes in the definition of hospital contacts and reduced intervention costs. Only in the most optimistic scenario combining the effects of all sensitivity analyses, does the incremental cost-effectiveness ratio fall below the UK thresholds values (€21 068 per quality-adjusted life-year).

Conclusions Telehealthcare is unlikely to be a cost-effective addition to usual care, if it is offered to all patients with chronic obstructive pulmonary disease and if the willingness-to-pay threshold values from the National Institute for Health and Care Excellence are applied.

Trial registration Clinicaltrials.gov, NCT01984840, 14 November 2013.

  • RCT
  • Telehealth
  • Telecare
  • Telemonitoring
  • COPD
  • Economic Evaluation
  • Cost-effectiveness
  • Denmark

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors OH is the principal investigator for the TeleCare North trial and LHE is lead investigator for the economic evaluation in the trial; LHE and OH planned the overall trial design and are guarantors of the statistical quality for the trial as a whole. FWU and PHL contributed to the detailed planning of the data collection of trial questionnaires. FWU planned and collected register data. FWU planned and conducted all analyses under the supervision of LHE and OH. FWU reported the analyses. All authors met regularly during and after the trial period and contributed as a whole to interpreting and the presentation of the data. All authors reviewed and approved the manuscript. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests None declared.

  • Ethics approval The Regional Ethical Committee for Medical Research in the North Denmark Region and the Danish Data Protection Agency.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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