GP Online, which, as we have previously noted, has been taking a strongly sceptical line on telehealth attended a Westminster Health Forum event in London yesterday, where the Whole System Demonstrator (WSD) cost evidence was apparently exposed in more detail than at the King’s Fund Congress in March.They liked what they heard even less:
‘Catherine Henderson, an LSE researcher, presented early findings from a separate economic analysis of the trial…Her team compared the likely benefit to patients to the costs of equipment, support and infrastructure needed to run the service at the time of the trial in 2009/10. Their analysis, which is yet to be peer reviewed, found telehealth would cost around £92,000 per quality-adjusted life year (QALY), the measure used by NICE to calculate the value of a drug or other medical product to the NHS. The watchdog has traditionally rejected drugs and other medical devices when this value climbs above £20,000-£30,000…Ms Henderson said: “On the basis of the results we concluded that it’s unlikely that the telehealth intervention is cost effective in terms of improving quality of life, in reference to the NICE willingness-to-pay threshold, the QALY.” The average annual cost was £1,850 per patient per year. Equipment costs are beginning to fall, Ms Henderson added, but would need to drop by 50% to 80% for a telehealth service to provide good value to the NHS.’
GP Online full report: Telehealth ‘three times over NICE cost limit’.
[i]”The average annual cost was £1,850 per patient per year. Equipment costs are beginning to fall, Ms Henderson added, but would need to drop by 50% to 80% for a telehealth service to provide good value to the NHS.
Even if prices fell by this amount, she said, there was only a 61% chance telehealth would be cost effective in the ‘most optimistic scenario’.”[/i]
Not encouraging is it. These results from Catherine may just be because Occupational Therapists were to lead the way on Telecare; as they were told by the College of Occupational Therapists back in 2006. Revenge is a dish best served cold.
What did we learn on Tues am?
(1) Analysis done on patient reported use of health services over a 3 month period multiplied by 4 to generate annual cost calculations. As Caterine acknowledged creates potential for error.
(2) Cost base was high at that point and has clearly fallen in the meantime.
(3) Its never been about the technology and is all about the new service models enabled by that technology.
(4) There are service efficiencies to be gleaned for example that are about reducing/eliminating unnecessary journeys, reducing the potential for hospitalisation etc.
(5) Creating efficiencies in the health service and releasing those efficiencies in hard cash are two different things particularly when savings will only be manifest at scale when beds are able to be removed from the system and new skill mixes/work flows introduced extensively.
(6) There are quality premiums to be realised through consistent practice and insights about disease progression to be revealed through analysis of trended data.
(7) Patients engaging more effectively in the management of their diseases can pay dividends.
(8) Face to face contact has to be value added as we simply won’t have the workforce to respond to the spectrum and volume of needs without intelligent prioritisation.
(9) The workforce needs to be supported to exploit the benefits.
(10) Users and carers need to be engaged from the outset and gain conviction that there are benefits for them.
(11) We have more work to do to realise the full benefits of new service models incorporating Telehealth and Telecare.
(12) We can’t afford not to deliver alternative models and levels of care enabled by technology going forward
I was talking to a colleague who attended the Westminster Health Forum event last week and he made an excellent point (he sometimes does).
Would you put a hip replacement into an elbow, a knee or a shoulder? No. Just because it is a joint doesn’t mean it will work on all joints. Therefore until the results of the WSD are available in a disease specific way then we will not be able to see in which condition(s) it works optimally.
It might take another ten years of sifting through the data but, hey, we waited this long.
Show us heart failure, COPD, diabetes etc specifics.
It is wrong to use the same measure used by NICE to calculate the value of a drug to assess Telehealth and the reason is: nobody assesses drugs: the measure is used to assess a specific drug/medicine. It is the same with telehealth. Telehealth can be any device or system. Many are the extension of old or existing devices.
However, she is correct to say that they need to be cost effective. And of course, safe!
A 76 year old relative agreed that £92,000 was a lot of money (not sure how well I explained the QALY to him) … he had a small stroke a few weeks ago, recovered very quickly and is back home 12 miles from his GP surgery. He has received excellent care from paramedics, hospital staff, the stroke liaison nurse and his GP practice. He is happy to take medication recently approved for clot busting in his situation and that doesn’t interfere with those that keep the lid on the swelling and pain of arthritis. [i]He doesn’t want to live for ever but he does want to live and not just sit down and wait to die[/i]!
Of course he isn’t driving just now so what does he do with the twice daily BP and pulse readings he is taking? He writes them in a notebook and is plotting a graph. These are important readings since both BP and pulse are fluctuating widely and they need to understand why. How does he share them with his clinicians – well just now he either has to phone and read them the numbers or wait until someone can take him to the GP/clinic.
He is reasonably computer literate and a recent convert to skype. Living rurally he has virtually non existent mobile signals so a smartphone isn’t going to work. Having thought for a few minutes about the QALY … his question was this? Well I don’t need a fancy thing that will take the readings – I have simple devices that do that already and I can tell my GP over the phone … but then she cannot do any kind of examination over the phone … why can’t I skype with my GP? I think I might not be popular with his GP when he sees her next week – I suggested he asked her this question?
You see it is not what it will cost in the future that has me thinking but rather, why would we throw away the value of that extremely good care he has already received – that the NHS has already accounted for – just because he is not enabled to do the self management and informed patient contribution to his own wellbeing that we keep getting told telehealth offers.