Health Economic Evaluation of Telehealthcare:Can we include “why” and “under what circumstances” telehealthcare is cost-effective in health economic evaluation?

Abstract

This thesis contains the results from the Danish TeleCare North trial meant to assess the effectiveness and cost-effectiveness of a telehealthcare solution implemented in North Denmark Region from 2013-2015. The TeleCare North trial demonstrated no difference in health-related quality of life and the telehealthcare solution was not cost-effective for all included COPD patients. But there was a potential to target the solution to patients with severe COPD. The results also indicate that implementation could have a strong impact on cost-effectiveness, more so than health- or socio-demographic factors. The results from the TeleCare North trial were used directly in a national decision to implement the telehealthcare solution to patients with severe COPD in Denmark and lead to considerable debate nationally. This debate could be viewed as an actual account of the usefulness of health economic evaluation for decision making meant to inform adaptation of the health economic evaluation approach. Based on developments in realist evaluation and experiences with conducting the evaluation of TeleCare North, four principles for health economic evaluation of complex telehealthcare interventions is outlined in order to facilitate future health economic designs of telehealthcare that should ultimately answer if telehealthcare is cost-effective, for whom, why and under what circumstances.<br/