The European Journal of Health Economics

, Volume 11, Issue 1, pp 45–55 | Cite as

The added value of thorough economic evaluation of telemedicine networks

  • Myriam Le Goff-PronostEmail author
  • Claude Sicotte
Original Paper


This paper proposes a thorough framework for the economic evaluation of telemedicine networks. A standard cost analysis methodology was used as the initial base, similar to the evaluation method currently being applied to telemedicine, and to which we suggest adding subsequent stages that enhance the scope and sophistication of the analytical methodology. We completed the methodology with a longitudinal and stakeholder analysis, followed by the calculation of a break-even threshold, a calculation of the economic outcome based on net present value (NPV), an estimate of the social gain through external effects, and an assessment of the probability of social benefits. In order to illustrate the advantages, constraints and limitations of the proposed framework, we tested it in a paediatric cardiology tele-expertise network. The results demonstrate that the project threshold was not reached after the 4 years of the study. Also, the calculation of the project’s NPV remained negative. However, the additional analytical steps of the proposed framework allowed us to highlight alternatives that can make this service economically viable. These included: use over an extended period of time, extending the network to other telemedicine specialties, or including it in the services offered by other community hospitals. In sum, the results presented here demonstrate the usefulness of an economic evaluation framework as a way of offering decision makers the tools they need to make comprehensive evaluations of telemedicine networks.


Telemedicine Economic evaluation Cost analysis Health care networks 

JEL Classification

D61 I19 O33 


  1. 1.
    Sisk, J.A., Sanders, J.H.: A proposed framework for economic evaluation of telemedicine. Telemed. J. 4, 31–37 (1998)Google Scholar
  2. 2.
    Pelletier-Fleury, N., Fargeon, V., Lanoe, J.L., Fardeau, M.: Transaction costs economics as a conceptual framework for the analysis of barriers to the diffusion of telemedicine. Health Policy. 42, 1–14 (1997). doi: 10.1016/S0168-8510(97)00038-9 CrossRefGoogle Scholar
  3. 3.
    Williams, T., May, C., Mair, F., Mort, M., Gask, L.: Normative models of health technology assessment and the social production of evidence about telehealth care. Health Policy. 64, 39–54 (2003). doi: 10.1016/S0168-8510(02)00179-3 CrossRefGoogle Scholar
  4. 4.
    Keen, J., Bryan, S., Muris, N., Weatherburn, G., Buxton, M.: Evaluation of diffuse technologies: the case of digital imaging networks. Health Policy. 34, 153–166 (1995). doi: 10.1016/0168-8510(95)00767-9 CrossRefGoogle Scholar
  5. 5.
    Hailey, D., Ohinmaa, A., Roine, R.: Study quality evidence of benefit in recent assessments of telemedicine. J. Telemed. Telecare. 10, 318–324 (2004). doi: 10.1258/1357633042602053 CrossRefGoogle Scholar
  6. 6.
    Roine, R., Ohinmaa, A., Hailey, D.: Assessing telemedicine: a systematic review of literature. CMAJ. 65, 765–771 (2001)Google Scholar
  7. 7.
    Withed, J.D.: The quality of telemedicine research. J. Telemed. Telecare. 12, 271–273 (2006). doi: 10.1258/135763306778558114 CrossRefGoogle Scholar
  8. 8.
    Whitten, P.S., Mair, F., Haycox, A., May, C.R., Williams, T.L., Hellmich, S.: Systematic review of cost effectiveness studies of telemedicine interventions. Br. Med. J. 324, 1434–7 (2002)Google Scholar
  9. 9.
    Hakansson, S., Gavelin, C.: What do we really know about the cost-effectiveness of telemedicine? J. Telemed. Telecare. 6(1), 133–136 (2000). doi: 10.1258/1357633001934438 CrossRefGoogle Scholar
  10. 10.
    Scott, J.: Telehealth outcomes: a synthesis of the literature and recommendations for outcome indicators. J. Telemed. Telecare. 13 (2007)Google Scholar
  11. 11.
    Pak, H.S., Datta, S.K., Triplett, C.A., Lindquist, J.H., Grambow, S.C., Whited, J.D.: Cost minimization analysis of a store-and-forward teledermatology consult system. Telemed. J. E. Health. 15(2), 160–165 (2009). doi: 10.1089/tmj.2008.0083 CrossRefGoogle Scholar
  12. 12.
    Morganti, A.G., Pasquarelli, L., Deodato, F., Digesù, C., Di Falco, C., Dinapoli, N., Macchia, G., Picardi, V., Tagliaferri, L., Valentini, V., Cellini, N.: Videoconferencing to enhance the integration between clinical medicine and teaching: a feasibility study. Tumori. 94(6), 822–829 (2008)Google Scholar
  13. 13.
    Dowie, R., Mistry, H., Young, T.A., Franklin, R.C., Gardiner, H.M.: Cost implications of introducing a telecardiology service to support fetal ultrasound screening. J. Telemed. Telecare. 14(8), 421–426 (2008). doi: 10.1258/jtt.2008.080401 CrossRefGoogle Scholar
  14. 14.
    Gomez-Ulla, F., Alonso, F., Aibar, B., Gonzalez, F.: A comparative cost analysis of digital fundus imaging and direct fundus examination for assessment of diabetic retinopathy. Telemed J. E. Health. 14(9), 912–918 (2008)CrossRefGoogle Scholar
  15. 15.
    Buysse, H., De Moor, G., Van Maele, G., Baert, E., Thienpont, G., Temmerman, M.: Cost-effectiveness of telemonitoring for high-risk pregnant women. Int. J. Med. Inform. 77(7), 470–476 (2008)CrossRefGoogle Scholar
  16. 16.
    Schaafsma, J., Pantazi, S.V., Moehr, J.R., Anglin, C.R., Grimm, N.A.: An economic evaluation of a telehealth network in British Columbia. J. Telemed. Telecare. 13(5), 251–256 (2007). doi: 10.1258/135763307781458877 CrossRefGoogle Scholar
  17. 17.
    Norum, J., Bergmo, T.S., Holdø, B., Johansen, M.V., Vold, I.N., Sjaaeng, E.E., Jacobsen, H.: A tele-obstetric broadband service including ultrasound, videoconferencing and cardiotocogram. A high cost and a low volume of patients. J. Telemed. Telecare 13(4), 180–184 (2007). doi: 10.1258/135763307780908085 CrossRefGoogle Scholar
  18. 18.
    Tsai, S.H., Kraus, J., Wu, H.R., Chen, W.L., Chiang, M.F., Lu, L.H., Chang, C.E., Chiu, W.T.: The effectiveness of video-telemedicine for screening of patients requesting emergency air medical transport (EAMT). J. Trauma 62(2), 504–511 (2007)CrossRefGoogle Scholar
  19. 19.
    Scalvini, S., Tridico, C., Glisenti, F., Giordano, A., Pirini, S., Peduzzi, P., Auxilia, F.: The SUMMA Project: a feasibility study on telemedicine in selected Italian areas. Telemed. J. E. Health. 15(3), 261–269 (2009). doi: 10.1089/tmj.2008.0109 CrossRefGoogle Scholar
  20. 20.
    Crow, S.J., Mitchell, J.E., Crosby, R.D., Swanson, S.A., Wonderlich, S., Lancanster, K.: The cost effectiveness of cognitive behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behav. Res. Ther. 47(6):451–453 (2009)Google Scholar
  21. 21.
    Moreno-Ramirez, D., Ferrandiz, L., Ruiz-de-Casas, A., Nieto-Garcia, A., Moreno-Alvarez, P., Galdeano, R., Camacho, F.M.: Economic evaluation of a store-and-forward teledermatology system for skin cancer patients. J. Telemed. Telecare 15(1), 40–45 (2009). doi: 10.1258/jtt.2008.080901 CrossRefGoogle Scholar
  22. 22.
    Smith, B., Hughes-Cromwick, P.F., Forkner, E., Galbreath, A.D.: Cost-effectiveness of telephonic disease management in heart failure. Am. J. Manag. Care. 14(2), 106–115 (2008)Google Scholar
  23. 23.
    Elliott, R.A., Barber, N., Clifford, S., Horne, R., Hartley, E.: The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines. Pharm. World. Sci. 30(1), 17–23 (2008)CrossRefGoogle Scholar
  24. 24.
    Bensink, M., Wootton, R., Irving, H., Hallahan, A., Theodoros, D., Russell, T., Scuffham, P., Barnett, A.G.: Investigating the cost-effectiveness of videotelephone based support for newly diagnosed paediatric oncology patients and their families: design of a randomised controlled trial. BMC. Health. Serv. Res. 7, 38 (2007)CrossRefGoogle Scholar
  25. 25.
    Jackson, K.M., Scott, K.E., Graff Zivin, J., Bateman, D.A., Flynn, J.T., Keenan, J.D., Chiang, M.F.: Cost-utility analysis of telemedicine and ophtalmoscopy for retinopathy of prematurity management. Arch. Ophthalmol. 126(4), 493–499 (2008). doi: 10.1001/archopht.126.4.493 CrossRefGoogle Scholar
  26. 26.
    Bott, O.J., Hoffmann, I., Bergmann, J., Gusew, N., Schnell, O., Gómez, E.J., Hernando, M.E., Kosche, P., von Ahn, C., Mattfeld, D.C., Pretschner, D.P.: HIS modelling and simulation based cost-benefit analysis of a telemedical system for closed-loop diabetes therapy. Int. J. Med. Inform. 76(Suppl 3), S447–S455 (2007)CrossRefGoogle Scholar
  27. 27.
    Bashshur, R.L.: Telemedicine effects: cost quality and access. J. Med. Syst. 19, 81–91 (1995). doi: 10.1007/BF02257059 CrossRefGoogle Scholar
  28. 28.
    McIntosh, E., Cairns, J.: A framework for the economic evaluation of telemedicine. J. Telemed. Telecare. 3, 132–139 (1997). doi: 10.1258/1357633971931039 CrossRefGoogle Scholar
  29. 29.
    Lobley, D.: The economics of telemedicine. J. Telemed. Telecare. 1996(3), 117–125 (1996)Google Scholar
  30. 30.
    Drummond, M.F., O’Brien, B., Stoddart, G.L., Torrance, G.W.: Methods for the economic evaluation of health care programmes. 2nd edn, Oxford University Press, Oxford (1997)Google Scholar
  31. 31.
    Armstrong, A.W., Dorer, D.J., et al.: Economic evaluation of interactive teledermatology compared with conventional care. Telemed. E. Health. 13(2), 91–99 (2007)CrossRefGoogle Scholar
  32. 32.
    Bergmo, T.S.: A cost minimization analysis of a realtime teledermatology service in northern Norway. J. Telemed. Telecare. 6, 273–277 (2000). doi: 10.1258/1357633001935905 CrossRefGoogle Scholar
  33. 33.
    Della Mea, V., Cortolezzis, D., Beltrami, C.A.: The economics of telepathology—a case study. J. Telemed. Telecare. 6(Suppl.1), 168–169 (2000)Google Scholar
  34. 34.
    Doolittle, G.C.: A cost measurement study for home-based telehospice service. J. Telemed. Telecare. 6(Suppl.1), 193–195 (2000)CrossRefGoogle Scholar
  35. 35.
    Bergmo, T.S.: An economic analysis of teleconsultation in otorhinolaryngology. J. Telemed. Telecare. 3, 194–199 (1997). doi: 10.1258/1357633971931156 CrossRefGoogle Scholar
  36. 36.
    Zollo, S., Kienzle, M., Loeffelholz, P., Sebille, S.: Telemedicine Iowa’s correctional facilities: initial clinical experience and assessment of program costs. Telemed. J. 5(3), 291–301 (1999). doi: 10.1089/107830299312041 CrossRefGoogle Scholar
  37. 37.
    Sicotte, C., Lehoux, P., VanDoesburg, N., Cardinal, G., Leblanc, Y.: A cost-effectiveness analysis of an interactive paediatric telecardiology network. J. Telemed. Telecare. 10(2), 78–83 (2004). doi: 10.1258/135763304773391503 CrossRefGoogle Scholar
  38. 38.
    Casey, F., Brown, D., Craig, B.G., Corrigan, N., McCord, B., Rogers, J., Mulholland, H.C., Quinn, M.: Value of a low-cost telemedicine link in the remote echocardiographic diagnosis of congenital heart defects. J. Telemed. Telecare. 4(Suppl 1), 46–48 (1998). doi: 10.1258/1357633981931416 CrossRefGoogle Scholar
  39. 39.
    Justo, R., Smith, A.C., Williams, M., Van der Westhuyzen, J., Murray, J., Sciuto, G., Wootton, R.: Paediatric telecardiology services in Queensland: a review of 3 years’ experience. J. Telemed. Telecare. 9(suppl.1), 57–59 (2004). doi: 10.1258/1357633042614258 CrossRefGoogle Scholar
  40. 40.
    McCue, M.J., Hampton, C.L., Malloy, W., Fisk, K.J., Dixon, L., Neece, A.: Financial analysis of telecardiology used in a correctional setting. Telemed. J. E. Health. 6(4), 385–391 (2000). doi: 10.1089/15305620050503852 CrossRefGoogle Scholar
  41. 41.
    Scalvini, S., Zanelli, E., Conti, C., Volterrani, M., Giordano, A., Castorina, M., Glisenti, F.: Potential cost reductions for the National Health Service through a telecardiology service dedicated to general practice physicians. Ital. Heart. J. 2(10), 1091–1097 (2001)Google Scholar
  42. 42.
    Shanit, D., Cheng, A., Greenbaum, R.A.: Telecardiology: supporting the decision-making process in general practice. J. Telemed. Telecare. 2(1), 7–13 (1996). doi: 10.1258/1357633961929105 CrossRefGoogle Scholar
  43. 43.
    Katz, M., Shapiro, C.: Technology adoption in the presence of network externalities. J. Polit. Econ. 94(4), 822–841 (1985). doi: 10.1086/261409 CrossRefGoogle Scholar
  44. 44.
    Tsuji, M. (2004) Economic evaluation of e-health System. Document RGQ14-1/2/021-E of International Telecommunication Union, 25–27 JuneGoogle Scholar
  45. 45.
    Bradford, W.D., Kleit, A.N., Krousel-Wood, M.A.: RE RM.: 2004, Willingness to pay for telemedicine assessed by the double-bounded dichotomous choice method. J. Telemed. Telecare. 10(6), 325–330 (2004) doi: 10.1258/1357633042601991
  46. 46.
    Quershi, A., Brandling-Bennett, H., Wittenberg, E., Chen, S., Kvedar, J.: Willingness-to-pay for clinic versus telemedicine in patients with psoriasis and melanoma. Telemed. J. E. Health. 10(1), 29–78 (2004). doi: 10.1089/153056204323057022 CrossRefGoogle Scholar
  47. 47.
    Brandling-Bennett, H.A., Kedar, I., Pallin, D.J., Jacques, G., Gumley, G.J., Kvedar, J.: Delivering health care in rural cambodia via store-and-forward telemedicine: a pilot study. Telemed. E-Health. 11(1), 56–62 (2005). doi: 10.1089/tmj.2005.11.56 CrossRefGoogle Scholar
  48. 48.
    Bergmo, T.S., Wangberg, S.C.: Patients’ willingness to pay for electronic communication with their general pratictioner. Eur. J. Health. Econ. 8, 105–110 (2007). doi: 10.1007/s10198-006-0014-5 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Telecom-Bretagne, Ecole Supérieure des Télécommunications de Bretagne, (LUSSI)/MARSOUIN/CREM, Département LUSSI, Logiques des UsagesSciences Sociales et Sciences de l’Information, GET/ENST-BretagneBrest Cedex 3France
  2. 2.Department of Health AdministrationUniversity of MontrealMontrealCanada

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