Measuring the cost-effectiveness of using telehealth for diabetes management: A narrative review of methods and findings

Introduction: Diabetes is a chronic metabolic disease characterized by high levels of blood glucose, which can lead over time to severe impairment to the heart, blood vessels, eyes, kidneys, nerves and premature death. Diabetes is prone to complications such as kidney failure, vision loss and nerve damage. The total assessed cost of diagnosed diabetes is growing rapidly; hence, harnessing telehealth for diabetes management may be costeffective. A few previous publications have pointed to the effectiveness of telehealth but more numerous articles indicate that the results are inconsistent and economic models are lacking. This narrative review surveys the recent literature on the implementation of telehealth for diabetes management that incorporates costeffectiveness analyses. Materials and methods: This paper follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [25]. Results: The vast majority of articles dealing with managing Type 2 diabetes have primarily used the telephone for telehealth monitoring (followed by teleophalmology and telemonitoring). Most publications report that the telehealth solution was cost effective. The leading cost-effectiveness method was the Markov model; however, only a small number of papers extend the Markov model to critical sensitivity analyses of their outcomes. The main goal of telehealth in general is diabetes management or monitoring, followed by ophthalmology, depression management, weight loss and other goals. Conclusion: This work summarizes the literature on recent trends in telehealth options, and analyzes successes and failures in relation to both effectiveness and costs, which may be valuable to both scholars and practitioners.