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Disappointing results from world’s largest telehealth trial

In a blow to operators’ ambitions for the telehealth market, results from the world’s largest randomised trial have cast doubt on the cost benefits of managing long-term conditions at home. The UK’s Whole System Demonstrator (WSD) program monitored the progress of 3,230 people with diabetes, pulmonary disease or heart failure over the course of 12 months from 2008-9. In the first of five peer-reviewed evaluations just published, academics from the Nuffield Trust and eight universities conclude that the reduction in hospital admission costs is “not significant”.

The two-year, £31m program was rolled out in three regions of the UK to test different impacts of telehealth and telecare. The results have been eagerly awaited around the world, reflecting both the size of the trial and its careful monitoring of control groups. A total of 6,191 patients and 238 GP practices took part overall.

In the first British Medical Journal paper, researchers focus on the impact of telehealth on mortality rates and readmissions to hospital. On the positive side, the patients were “significantly less likely to die” within the 12 months than the control group, and hospital stays were measurably shorter. However, the reduction in the number of hospital visits was too small to be accurately measured. Consequently, the impact on costs was deemed insignificant. In any case, the size of the cost saving totaled only £188 per patient over the year – a drop in a very large test-tube, compared with the upfront technology investment required.

The cost findings will be frustrating for telehealth advocates, especially as services were shown to have prolonged lives – a notable 45 per cent improvement in mortality rate over the control group. But the cost equation must be solved if healthcare providers are to invest both in the technology and inevitable organizational disruption.

Of course, such a complex trial cannot hope to exclude all possible influences. The researchers point out that a relatively high number of ‘low-risk’ participants were recruited, whereas real services can be targeted at patients at more advanced stages of illness. And 12 months just might not be long enough to capture responses to such an unfamiliar patient-doctor interaction.

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Four more papers will be published later this year, focusing on patient quality of life and organizational factors, as well as costs. Operators will be hoping for a less equivocal outcome.

In the meantime, the UK government continues to cite the preliminary, more optimistic results from last year in support of its 3 Million Lives policy. BT Health, O2 Health and Cisco are among the communications companies leading the program to promote of telehealth and telecare across the country over the next five years.

It’s a political prerogative to be selective about academic evidence. But healthcare providers will look to industry for a stronger case that these services equip them to tackle the twin challenges of aging populations and reduced budgets.

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