Economic evaluation methods applied to telemedicine: From a literature review to a standardized framework

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Context: Telemedicine is proposed as a useful tool to increase efficiency, improve access and the quality of care. The widespread use of telemedicine has created the need to evaluate its efficiency. This implies that we need use appropriate evaluation methods. In this context, what lessons can be learned from previous economic evaluation studies? The first objective was to explore economic evaluation studies of telemedicine in terms of their descriptive analysis, methodological quality and the main shortcomings of the methodology. The second objective was to identify a standardized framework for economic evaluation, with a view to providing a tool for policymakers and stakeholders. Method: The analysis was based on a review of the literature from 2000 to 2013. We identified 286 potential articles. The selection and analysis of the studies led to excluding 159 articles. After reviewing the full-text articles, 74 studies that implemented an economic evaluation for a telemedicine project and 27 systematic reviews on economic evaluation (including 5 French ones) remained. 26 partial economic evaluations that only focus on costs were excluded. A standardised analysis framework was developed in collaboration with a methodological working group, based on the results of literature review and the study of existing projects. Results: Two main results appear: an important heterogeneity of the publications which leads to the impossibility of comparing the results and adjudicate on a possible efficiency of telemedicine and a poor quality of the cost-effectiveness method used for telemedicine. These findings are consistent with those of the systematic reviews of the literature examined. An update of the literature review was made from 2013 to 2017. Economic evaluation protocols are actually more sophisticated. The use of economic evaluation to assess the economic consequences of telemedicine interventions requires adequate use of standard methodology. The French National Authority for Health has proposed the development of an impact matrix showing the expected effects of telemedicine on the various stakeholders. Conclusions: While the results of economic evaluation studies can be criticized in terms of methodology and are not very decisive, the recommendations relating to implementing economic evaluations were identified to promote a coherent development of economic evaluations. The methodological framework presented here is not considered as an end in itself but rather than the beginning of what is hoped will be an ongoing process of telemedicine evaluation.