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What is already known on this topic
The use of telemedicine has garnered much attention in the past decade
Hundreds of articles have been published claiming that telemedicine is cost effective
However, missing from the literature is a synthesis or meta-analysis of these publications
What this study adds
A comprehensive literature search of cost related articles on telemedicine identified more than 600 articles, but only 9% contained any cost benefit data
Only 4% of these articles met quality criteria justifying inclusion in a formalised quality review, and most of these were small scale, short term, pragmatic evaluations with few generalisable conclusions
There is little published evidence to confirm whether or not telemedicine is a cost effective alternative to standard healthcare delivery
Introduction
Proponents of telemedicine have championed its potential economic benefits in recent years. In Britain telemedicine systems have been proposed as a cost effective means of responding to structural problems in the organisation of the NHS. 1 2 In the United States telemedicine systems have been used, especially in rural areas, as a means of easing the problem of obtaining specialist advice and making referrals over wide distances. 3 Even so, major questions about the cost effectiveness of telemedicine systems remain because the data used to support such claims are dispersed across studies of widely differing systems and diverse organisational contexts. Reported studies are often small in scale, methodologically flawed, and reflect pragmatic evaluations rather than controlled trials, making them unsuitable for formal meta-analysis. 4 Given these problems, our objective was to address the question of whether the existing literature allows any conclusions to be drawn about the cost effectiveness of telemedicine interventions.
Telemedicine is defined here as clinical practice for diagnosis, review, or management undertaken synchronously or asynchronously through the medium of information and telecommunications technologies (excluding telephone and fax).
Methods
Two independent systematic reviews were started, one in the United States (Whitten and colleagues) and the other in Britain (Mair and colleagues). When each group became aware of the other's work it was decided to adopt a common strategy and share results, while still reviewing articles independently. As a result, both groups performed analyses on articles obtained through a common search strategy. Both groups categorised articles into those with or without data....