UPDATED: The cost effectiveness of a key part of the government’s innovation strategy has been called into question in an official evaluation.
Findings regarding the impact of telehealth technology used in a huge research programme called the “whole system demonstrator” were presented at the King’s Fund today. They revealed the cost per quality adjusted life year, including direct costs, was in the region of £80,000.
The QALY threshold used by the National Institute for Health and Clinical Excellence to determine the cost effectiveness of treatments is between £20,000 and £30,000.
Only yesterday, health minister Paul Burstow said: “The widespread adoption of telehealth and telecare as part of an integrated care plan…delivered from the front line…could save the NHS up to £1.2 billion over five years.”
The Nuffield Trust was contracted by the Department of Health to measure the impact of telehealth technology used in called the whole system demonstrator.
Director Jennifer Dixon told an audience at last week’s Nuffield Trust summit that returns from the evaluation showed “very disappointing results in emergency admissions”.
The potential for telehealth to keep people with long term conditions out of hospital is one of its main selling points.
“Early headline findings” of the trial released by the Department of Health in December had shown “a 20 per cent reduction in emergency admissions”.
Other “indications” published by the DH included a “15 per cent reduction in A&E visits, a 14 per cent reduction in elective admissions, a 14 per cent reduction in bed days and an 8 per cent reduction in tariff costs” and “a 45 per cent reduction in mortality rates”.
In December, David Cameron launched a drive to get “assistive technology” like telehealth used by three million people over five years.
Full results of the two-year whole system demonstrator trial have not yet been released, with the DH saying only that they would be made public “in due course”.
The trial had nearly 6,000 participants and is thought to be the largest randomised trial of the technologies in the world.
It was led by Stan Newman of the school of health sciences at London’s City University. The Nuffield Trust looked at the impact on the use of NHS and social services, and the costs.
A Nuffield Trust spokesman said on Tuesday: “The results from the evaluation are due to be published in peer reviewed journals shortly. The Nuffield Trust therefore does not wish to pre-empt the findings of this process.”
Dr Dixon’s statement came after the King’s Fund called for the release of the full data. Nick Goodwin, a senior fellow in health policy at the think tank, last week said commissioners needed to know what the whole system demonstrator trial “really shows” rather than just the headline results.
The summit also heard from Geoff Mulgan of innovation body Nesta, which has made its own assessment of technology and long term conditions.
He said communications technology was now so cheap “we have almost reached the conclusion that any expensive equipment that is meant to keep people out of hospital isn’t going to work”.
Don Berwick, one of the architects of the US Medicare reforms, told the summit: “I heard this morning there were some doubts about the effectiveness [of telehealth]. I became a real fan of telemedicine, it should lower cost and improve quality.”
A Department of Health spokesman said: “The WSD programme is the largest randomised control trial of telehealth and telecare anywhere in the world. It is an incredibly complex piece of research. The full dataset will continue to be analysed over the coming months by the six universities involved. The first set of papers detailing findings are with the British Medical Journal awaiting final sign-off following peer review, and we look forward to their imminent publication.”