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The Cost-Utility of a Home-Telehealth Program for Veterans with Diabetes

Chumbler NR, Vogel WB, Barnett TE, Beyth RJ. The Cost-Utility of a Home-Telehealth Program for Veterans with Diabetes. Paper presented at: VA HSR&D National Meeting; 2006 Feb 16; Arlington, VA.


Objectives:To determine whether a care coordination/home-telehealth (CCHT) program for frail, community-dwelling veterans with diabetes is cost-effective. Methods:The CCHT program, implemented at 4 VAMC sites in a single VISN, targeted veterans with diabetes who were at high risk for expensive, multiple inpatient and outpatient visits (including VA emergency department visits). Veterans with diabetes were included if they had 2 or more VA hospitalizations or VA ED visits in the 12 months preceding enrollment. They also needed to be non-institutionalized and have access to telephone service. The CCHT program consisted of a care coordinator who employed disease management principles through the care continuum, managed treatment, and provided the veteran with self-management skills to avert potentially costly service visits (e.g., hospitalizations). The predominant form of home-telehealth technology used at each site was a home messaging device that plugged into the patient's phone. The veterans used this device daily to answer questions about their diabetes care. We used the SF-36V questionnaire at baseline and 12-month follow-up and have valid data for 370 enrollees. We calculated a quality of life utility score to assess the change in health status during the year of the program. We also calculated the change in cost for the participants. The net benefit was calculated using cost-effectiveness threshold measures of $50,000 and $100,000 per quality-adjusted life year.Results:Overall, the program was not cost-effective for the entire population of enrolled veterans with diabetes (mean = $-4702 ($50,000) and $-4115 ($100,000)). However, the program was cost-effective for 33% (N = 123) of the respondents. We found that both VAMC program site and patient race predicted the cost-effectiveness for respondents. Age, marital status, disability, and chronic diseases (e.g. CHF, depression, etc.) were not correlated with cost-effectiveness.Implications:Although the program was not deemed cost-effective for the entire sample, it was cost-effective for a substantial number of participants which suggests the program could be targeted differently in future implementations to achieve overall cost-effectiveness. Impacts:With better targeting of enrollment, this VA CCHT intervention can achieve overall cost-effectiveness, thereby helping justify the VA's expanding investment in home-telehealth technology through improving the health of veterans while controlling costs.

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