Re: Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial
In Steventon et al ‘s report on the effect of telehealth on use of secondary care and mortality the apparent benefits in the intervention arm appear to be driven largely by an unexplained increase in adverse events in the control arm following entry to the study.1 A possible explanation for this is that although this was intended to be a “usual care” arm the resources available to deliver usual care had in fact been diverted to provide the trial intervention. The methods state that the telehealth monitoring centres were “staffed by specialist nurses and community matrons from local health organisations” which must mean that they had been diverted from previous roles.
A particular anxiety in COPD has been that resources will be diverted towards unproven telehealth interventions at the expense of high-value interventions with a strong evidence base, specifically pulmonary rehabilitation which remains significantly under-provided in the UK. 2 3 Preliminary findings from the Whole System Demonstrator program presented at the King's Fund suggested the cost per quality adjusted life year (QALY) was in the region of £80,000. As outlined in the accompanying editorial,4 the evaluation of telehealth interventions is complex and needs to be considered within the wider health context. This must include the opportunity costs of investment of finite healthcare resources in this area.
1. Steventon A, Bardsley M, Billings J, Dixon J, Doll H, Hirani S, et al. Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ 2012;344.
2. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006(4):CD003793.
3. Dodd JW, Hogg L, Nolan J, Jefford H, Grant A, Lord VM, et al. The COPD assessment test (CAT): response to pulmonary rehabilitation. A multicentre, prospective study. Thorax 2011;66(5):425-29.
4. Car J, Huckvale K, Hermens H. Telehealth for long term conditions. BMJ 2012;344.
Competing interests:
No competing interests
02 July 2012
Nicholas S Hopkinson
Clinical Senior Lecturer and Hon Consultant Chest Physician
NIHR Biomedical Research Unit at Royal Brompton Hospital and Imperial College, London
Royal Brompton Hospital, Fulham Rd, London SW3 6NP
Rapid Response:
Re: Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial
In Steventon et al ‘s report on the effect of telehealth on use of secondary care and mortality the apparent benefits in the intervention arm appear to be driven largely by an unexplained increase in adverse events in the control arm following entry to the study.1 A possible explanation for this is that although this was intended to be a “usual care” arm the resources available to deliver usual care had in fact been diverted to provide the trial intervention. The methods state that the telehealth monitoring centres were “staffed by specialist nurses and community matrons from local health organisations” which must mean that they had been diverted from previous roles.
A particular anxiety in COPD has been that resources will be diverted towards unproven telehealth interventions at the expense of high-value interventions with a strong evidence base, specifically pulmonary rehabilitation which remains significantly under-provided in the UK. 2 3 Preliminary findings from the Whole System Demonstrator program presented at the King's Fund suggested the cost per quality adjusted life year (QALY) was in the region of £80,000. As outlined in the accompanying editorial,4 the evaluation of telehealth interventions is complex and needs to be considered within the wider health context. This must include the opportunity costs of investment of finite healthcare resources in this area.
1. Steventon A, Bardsley M, Billings J, Dixon J, Doll H, Hirani S, et al. Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ 2012;344.
2. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006(4):CD003793.
3. Dodd JW, Hogg L, Nolan J, Jefford H, Grant A, Lord VM, et al. The COPD assessment test (CAT): response to pulmonary rehabilitation. A multicentre, prospective study. Thorax 2011;66(5):425-29.
4. Car J, Huckvale K, Hermens H. Telehealth for long term conditions. BMJ 2012;344.
Competing interests: No competing interests