Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Mar 10, 2023
Date Accepted: Jul 26, 2023
Economic evaluation of telerehabilitation: a systematic literature review of cost-utility studies
ABSTRACT
Background:
Telerehabilitation could benefit to a large population by increasing adherence to rehabilitation protocols.
Objective:
Our objective was to review and discuss the use of cost-utility approaches in the economic evaluations of telerehabilitation interventions.
Methods:
The review of Pubmed, Scopus, CRD, Cochrane Library and clinicaltrials.gov (last search on February 8, 2021) was conducted in accordance with PRISMA guidelines. The inclusion criteria were defined according to the PICOS system: included articles had to evaluate patients in all disease rehabilitation (P), through exercise-based telerehabilitation (I) and who had a control group that performed a face-to-face rehabilitation (C), that evaluated effectiveness through gain in quality of life (O) and used the design of randomized and controlled clinical studies (S).
Results:
We included 11 economic evaluations and 6/11 concerned cardiovascular diseases. Several types of intervention were assessed as Telehealth monitoring at home (monitored by physicians) or telerehabilitation program with exercise and education intervention at home. All studies were based on randomized clinical trials and used a validated HR-QoL instrument to describe patients’ health states. Four evaluations used the EQ-5D, one used the EQ-5D-5L, two used the EQ-5D-3L, three used the SF-6D and one the SF-36.The mean QALYs gained using telerehabilitation services varied from -0.09 to 0.89. These results were reported in terms of probability that the intervention was cost-effective at different thresholds for willingness-to-pay values. Most studies showed results about telerehabilitation as dominant, less costly together with superiority or non-inferiority in outcomes.
Conclusions:
There is evidence to support telerehabilitation as cost-effective intervention to a large population among different disease areas. There is a need for conducting cost-effectiveness studies in countries because the available evidence has limited generalizability to such countries. Clinical Trial: PROSPERO CRD42021248785
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