Background: Telemedicine has been advocated as an effective means to provide health care\r\nservices over a distance. Systematic information on costs and consequences has been called for to\r\nsupport decision-making in this field. This paper provides a review of the quality, validity and\r\ngeneralisability of economic evaluations in telemedicine.\r\nMethods: A systematic literature search in all relevant databases was conducted and forms the\r\nbasis for addressing these issues. Only articles published in peer-reviewed journals and written in\r\nEnglish in the period from 1990 to 2007 were analysed. The literature search identified 33\r\neconomic evaluations where both costs (resource use) and outcomes (non-resource\r\nconsequences) were measured.\r\nResults: This review shows that economic evaluations in telemedicine are highly diverse in terms\r\nof both the study context and the methods applied. The articles covered several medical specialities\r\nranging from cardiology and dermatology to psychiatry. The studies analysed telemedicine in home\r\ncare, and in primary and secondary care settings using a variety of different technologies including\r\nvideoconferencing, still-images and monitoring (store-and-forward telemedicine). Most studies\r\nused multiple outcome measures and analysed the effects using disaggregated cost-consequence\r\nframeworks. Objectives, study design, and choice of comparators were mostly well reported. The\r\nmajority of the studies lacked information on perspective and costing method, few used general\r\nstatistics and sensitivity analysis to assess validity, and even fewer used marginal analysis.\r\nConclusion: As this paper demonstrates, the majority of the economic evaluations reviewed were\r\nnot in accordance with standard evaluation techniques. Further research is needed to explore the\r\nreasons for this and to address how economic evaluation in telemedicine best can take advantage\r\nof local constraints and at the same time produce valid and generalisable results.
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