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We are grateful to Khai Tran, Karen Cimon, Eike-Henner W. Kluge, Hussein Noorani, Krisan Palmer, and Richard Scott for their contribution to the project. Conflict of interest: None declared. This project was funded by the Canadian Agency for Drugs and Technologies in Health (CADTH).
Chronic diseases are prolonged conditions that normally do not improve with time and are rarely cured completely (5). They may cause premature deaths, decrease quality of life (QoL) of individuals, and have a negative economic impact on the individuals' families and society (36). According to the World Health Organization, noncommunicable diseases, such as cardiovascular diseases, diabetes, obesity, cancer, and respiratory diseases, currently account for 59 percent of the 57 million annual deaths and 46 percent of the global burden of disease (48). A 2007 study stated that the total costs of chronic disease in 2003 in the United States alone was US$1,324 trillion dollars (treatment expenditures = US$277 billion and lost productivity = US$1,047 trillion dollars) (15).
Advancements in treatment for chronic diseases have resulted in reduced length of hospital stay, and in some cases, the avoidance of hospital visits, so the demand for home care services has increased (41). Healthcare providers can deliver home care services by visiting a patient's home or by using information and communication technology, also known as home telehealth. Home telehealth is a subset of telehealth that brings healthcare delivery to the home environment by connecting the patient with medical professionals. It is not intended to replace health professional care or visits, but rather to enhance the level of care (7).
The research objectives were to systematically review the current literature on the cost-effectiveness home telehealth and to provide a framework for economic evaluations of home telehealth to assist future studies. The economic review is limited to three chronic conditions that are the most studied with respect to home telehealth: diabetes, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD). In developed countries, CHF is diagnosed in 1-2 percent of the general population (6), and an estimated more than 180 million people worldwide have diabetes (46), and approximately 210 million people globally have COPD (47). Usual care involves follow-up by a primary care physician or specialist after patient discharge...