METHODS FOR ECONOMIC EVALUATION OF TELEMEDICINE: AN OVERVIEW
Abstract
Telemedicine has evolved from a supplementary modality into an essential component of modern healthcare systems. Remote consultations, telemonitoring and other virtual care models are increasingly integrated into routine clinical pathways, particularly in chronic disease management and settings with limited access to in-person services. Telemedicine improves accessibility, continuity of care and reduces avoidable hospitalizations while enhancing patient routing efficiency. At the same time, it represents a resource-intensive and organizationally complex health technology requiring investment in digital infrastructure, software platforms, cybersecurity, workforce training and interoperability with electronic health systems. Therefore, clinical effectiveness alone is insufficient for large-scale adoption, and decision-makers require evidence of economic efficiency and affordability within Health Technology Assessment frameworks. Telemedicine functions as a complex intervention whose outcomes depend on interacting determinants including patient characteristics, clinical protocols, technological features, organizational workflows and digital literacy, limiting transferability of results across contexts. The study systematizes major economic evaluation approaches applied to telemedicine, including cost-effectiveness, cost-utility, budget impact and cost-consequence analyses, with emphasis on cost measurement, outcome valuation and uncertainty assessment. The methodological design combines systematic and scoping review elements aligned with PRISMA 2020 and CHEERS 2022 standards. Included studies compared telemedicine interventions with usual care and reported analytical perspective, time horizon and uncertainty analysis. Results indicate predominance of cost-effectiveness and cost-utility analyses, while budget impact analysis remains insufficiently applied despite its importance for implementation decisions. Economic benefits are mainly associated with reduced hospitalizations and quality-of-life improvements. Key methodological challenges include accurate costing, long-term outcome modeling and sensitivity to adoption rates and infrastructure costs. Telemedicine evaluation therefore requires integrated assessment of effectiveness, economic efficiency and affordability to support evidence-based healthcare decision-making.
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