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Open Access Highly Accessed Research article

Using QALYs in telehealth evaluations: a systematic review of methodology and transparency

Trine S Bergmo

Author Affiliations

Norwegian Centre for Telemedicine and Integrated Care, University Hospital of North Norway, N-9038 Tromsø Norway

BMC Health Services Research 2014, 14:332  doi:10.1186/1472-6963-14-332

Published: 3 August 2014

Abstract

Background

The quality-adjusted life-year (QALY) is a recognised outcome measure in health economic evaluations. QALY incorporates individual preferences and identifies health gains by combining mortality and morbidity into one single index number. A literature review was conducted to examine and discuss the use of QALYs to measure outcomes in telehealth evaluations.

Methods

Evaluations were identified via a literature search in all relevant databases. Only economic evaluations measuring both costs and QALYs using primary patient level data of two or more alternatives were included.

Results

A total of 17 economic evaluations estimating QALYs were identified. All evaluations used validated generic health related-quality of life (HRQoL) instruments to describe health states. They used accepted methods for transforming the quality scores into utility values. The methodology used varied between the evaluations. The evaluations used four different preference measures (EQ-5D, SF-6D, QWB and HUI3), and utility scores were elicited from the general population. Most studies reported the methodology used in calculating QALYs. The evaluations were less transparent in reporting utility weights at different time points and variability around utilities and QALYs. Few made adjustments for differences in baseline utilities. The QALYs gained in the reviewed evaluations varied from 0.001 to 0.118 in implying a small but positive effect of telehealth intervention on patient’s health. The evaluations reported mixed cost-effectiveness results.

Conclusion

The use of QALYs in telehealth evaluations has increased over the last few years. Different methodologies and utility measures have been used to calculate QALYs. A more harmonised methodology and utility measure is needed to ensure comparability across telehealth evaluations.

Keywords:
Telehealth; Telemedicine; Videoconferencing; Remote consultations; E-Health; Health-related quality of life; Quality-adjusted life-years; Cost-utility analysis