Cost-effectiveness, use and implementation of telehealth solutions for CHF and COPD: A systematic review using the PRISMA method

Background

According to leading health organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), telehealth applications have the potential to improve patients' health, particularly for the billions of patients suffering from chronic diseases such as Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD). While telehealth solutions hold promise, there is currently inadequate clinical evidence supporting their use in public health surveillance and home-based care, making it difficult to draw decisive conclusions.

Objective

The objective of this work was to evaluate the cost-effectiveness, use, and implementation of telehealth solutions for patients with chronic diseases, specifically CHF and COPD, through a review of the current literature. This narrative review examined studies presenting cost-effectiveness analyses, use, and implementation of telehealth for these patients.

Methods

This work implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In order to receive recency and to examine recent and innovative telehealth solutions, articles published in English from 2010 to 2023 were included in the search. The inclusion criteria were papers on telehealth tools employed for CHF and COPD patients that assessed their cost-effectiveness.

Results

The majority of the studies were conducted in Europe. Approximately half had an adequate sample size and tracked patients prospectively for a sufficient duration. The most frequently used telehealth method was distance monitoring, with only a few studies incorporating home visits or phone calls. The parameters monitored included blood pressure, oxygen saturation, heart rate, and spirometry, among others. General statistical analyses and regression models were the most frequently used methods, although several studies incorporated Markov models and simulations.

Discussion

The majority of the papers (20 out of 26) concluded that the tools implemented led to either cost-effectiveness, cost-savings or strongly dominance. This promising result shows that telehealth is an important topic that deserves further research on its effectiveness as well as cost-effectiveness for chronic disease management.

Limitations

One key limitation of this PRISMA review is that the literature search was restricted to two major diseases, and the language of the publications was exclusively English. Thus, the generalizability of the findings to other chronic diseases is subject to caution.