Cost Comparison Between Telemonitoring and Usual Care of Heart Failure: A Systematic Review
Abstract
Heart failure (HF) is associated with high direct and indirect costs to the patients and the healthcare system. This systematic review aims to analyze existing economic data to determine whether telemonitoring of patients with HF will result in decreased costs. The Scopus and PubMed databases were searched independently by two reviewers for journal articles that reported on an economic analysis (i.e., calculated monetary amounts or percentage change in costs) of a study using a HF telemonitoring system. Only articles describing telemonitoring systems with a component of home physiological measurements were included. Eleven articles met the inclusion criteria, describing 10 different HF telemonitoring systems. Nine of the 10 studies analyzed the direct costs to the healthcare system. All the studies found cost reductions from telemonitoring compared to usual care, which ranged between 1.6% and 68.3%. Cost reductions were mainly attributed to reduced hospitalization expenditures. Only one study discussed the impact of HF telemonitoring on direct patient costs. The study found a 3.5% lower travel cost for patients using telemonitoring compared to those in the usual care group. The single study that was found for indirect costs described the willingness to pay for telemedicine by patients with HF (55% of the patients with HF were willing to pay $20 to access telemedicine, and 19% were willing to pay $40). Available data from existing studies suggest that although HF telemonitoring will require an initial financial investment, it will substantially reduce costs in the long term, particularly by reducing rehospitalization and travel costs.
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The majority of systematic reviews (10/15, 67%) summarized and reported relevant information about the type of physiological measures monitored in the included trials.
“While the majority of systematic reviews (10/15, 67%) summarized and reported relevant information about the type of physiological measures monitored in the included trials [33,34,37,38,41-44,47,49]”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [42]
One review of both RCTs and observational studies that focused explicitly on cost savings as an outcome found direct cost reductions to the health care system from HT compared to usual care, which ranged between 1.6% and 68.3%.
“One review of both RCTs and observational studies that focused explicitly on cost savings as an outcome found direct cost reductions to the health care system from HT compared to usual care, which ranged between 1.6% and 68.3% [42].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [42]
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Zakiyah, N., Marulin, D., Alfaqeeh, M., Puspitasari, I. M., Lestari, K., Lim, K. K., & Fox-Rushby, J. A. (2024) · Journal of Medical Internet Research · doi:10.2196/53500 · Cited by 33 · see citing works
“Such systems also enable remote patient monitoring, reducing the burden on hospitals and health care resources and potentially leading to overall cost savings [67].”
Conway, A., Inglis, S. C., Chang, A. M., Horton-Breshears, M., Cleland, J. G. F., & Clark, R. A. (2013) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x13503427 · Cited by 31 · see citing works
“Cost Two of the systematic reviews examined the costeffectiveness of remote monitoring for heart failure.(11,24) In the meta-analysis reported by Klersy et al.”
BackgroundTrends in Outpatient Telemedicine Utilization Among Rural Medicare Beneficiaries, 2010 to 2019
Barnett, M. L., Huskamp, H. A., Busch, A. B., Uscher‐Pines, L., Chaiyachati, K. H., & Mehrotra, A. (2021) · JAMA Health Forum · doi:10.1001/jamahealthforum.2021.3282 · Cited by 30 · see citing works
Davis, S. P., Ross, M., Adatorwovor, R., & Wei, H. (2020) · Research in Nursing & Health · doi:10.1002/nur.22091 · Cited by 28 · see citing works
A Standardized SOA for Clinical Data Interchange in a Cardiac Telemonitoring Environment
Gazzarata, R., Vergari, F., Cinotti, T. S., & Giacomini, M. L. (2014) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2014.2334372 · Cited by 30 · see citing works
A Review of Three-Layer Wireless Body Sensor Network Systems in Healthcare for Continuous Monitoring
Chen, C., Knoll, A., & Horsch, A. (2013) · Cited by 29 · see citing works
Challenges for remote patient monitoring programs in rural and regional areas: a qualitative study
Tagne, J. F., Burns, K., O’Brein, T., Chapman, W. W., Cornell, P. Y., Huckvale, K., Ameen, I., Bishop, J. L., Buccheri, A., Reid, J., et al. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12427-z · Cited by 36 · see citing works
“…potential to enhance patient satisfaction, reduce hospital readmissions, and improve the management of chronic diseases such as in heart disease [14], disparities in RPM access could leave some populations behind, leading to poorer care coordination, unnecessary hospital expenditures, and…”
Heart Rate Variability on 7-Day Holter Monitoring Using a Bootstrap Rhythmometric Procedure
Goya–Esteban, R., Mora-Jiménez, I., Rojo‐Álvarez, J. L., Barquero‐Pérez, Ó., Pastor‐Pérez, F. J., Manzano‐Fernández, S., Pascual-Figal, D. A., & Garcı́a-Alberola, A. (2010) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2010.2040899 · Cited by 27 · see citing works
“Several studies have shown that home monitoring can reduce significantly the number of hospital readmissions in congestive heart failure (CHF) patients [1], [2].”
BackgroundVitacca, M., Bazza, A., Bianchi, L. N. C., Gilè, S., Assoni, G., Porta, R., Bertella, E., Fiorenza, D., Barbano, L., Comini, L., et al. (2010) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2009.0115 · Cited by 26 · see citing works
“6, 16 Simulation model has been proposed to plan hospital bed necessity, 17 sanitary staff being the highest cost.”
A critical review on telemonitoring in heart failure
Gurné, O., Conraads, V. M., Missault, L. H., Müllens, W., Vachiéry, J., Mieghem, W. V., Droogné, W., Pouleur, A., Troisfontaines, P., Huez, S., et al. (2012) · Acta cardiologica. Supplementum · doi:10.1080/ac.67.4.2170685 · Cited by 25 · see citing works
Patel, P., Dhindsa, D. S., Eapen, D. J., Khera, A., Gulati, M., Stone, N. J., Yancy, C. W., Rumsfeld, J. S., & Sperling, L. S. (2021) · The American Journal of Medicine · doi:10.1016/j.amjmed.2021.03.007 · Cited by 25 · see citing works
“A systematic review of 10 different heart failure telemonitoring systems also demonstrated a reduction in costs related to hospital admissions.(11) Costs to a clinical practice may be reduced when a large number of visits are via telemedicine, creating opportunity for needed in-person visits.”
BackgroundHafkamp, F. J., Tio, R. A., Otterspoor, L., Greef, T. V.-D., van Steenbergen, G. J., van de Ven, A. R. T., Smits, G., Post, H., & van Veghel, D. (2022) · Heart Failure Reviews · doi:10.1007/s10741-021-10212-8 · Cited by 24 · see citing works
“Therefore, the reduction of hospitalizations is the most promising factor as target to improve patients’ reported experiences or outcomes and to reduce the costs of HF management [25, 41, 42].”
BackgroundSanchez‐Ramirez, D. C., Pol, M., Loewen, H., & Choukou, M.-A. (2022) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x221122124 · Cited by 24 · see citing works
“87 Overall, evidence suggested that telemonitoring and tel-erehabilitation are potentially valuable mechanisms to improve patient care and access, especially in rural areas, 88 and do not increase mortality rates.”
BackgroundSaponara, S., Donati, M., Bacchillone, T., Sanchez-Tato, I., Carmona, C., Fanucci, L., & Barba, P. (2012) · IEEE Sensors Applications Symposium (SAS) · doi:10.1109/sas.2012.6166310 · Cited by 24 · see citing works
“telemonitoring or structured telephone support, can avoid a large portion of readmissions related to heart-failure, with benefit also in mortality, length of hospital stay and quality of life [9].”
BackgroundDelivery of Patient-Reported Outcome Instruments by Automated Mobile Phone Text Messaging
Anthony, C. A., Lawler, E. A., Glass, N. A., McDonald, K., & Shah, A. S. (2017) · HAND · doi:10.1177/1558944716672201 · Cited by 22 · see citing works
“Previous work has considered relative costs and benefits to patients and providers when various traditional telehealth programs are utilized.(12,22,24) Traditionally, patients have answered inoffice PRO questionnaires on paper or through computer interfaces.”
BackgroundEconomic Evaluation of Manitoba Health Lines in the Management of Congestive Heart Failure
Cui, Y., Doupe, M. B., Katz, A., Nyhof, P., & Forget, E. L. (2013) · Healthcare policy · doi:10.12927/hcpol.2013.23620 · Cited by 22 · see citing works
“A few international studies show that telehealth can be an effective method to reduce healthcare utilization rates and costs as well as improve quality of life for people with CHF (Clark et al. 2007; Jennett et al. 2003; Noel et al. 2004; Schmidt et al. 2010; Seto 2008; Wooden et al. 2008).”
BackgroundAskari, A., Khodaie, M., & Bahaadinbeigy, K. (2014) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x13519899 · Cited by 22 · see citing works
Usefulness of a Telemedicine Program in Refractory Older Congestive Heart Failure Patients
Burdese, E., Testa, M., Raucci, P., Ferreri, C., Giovannini, G., Lombardo, E., Avogadri, E., & Feola, M. (2018) · Diseases · doi:10.3390/diseases6010010 · Cited by 21 · see citing works
“3% from telemonitoring when compared to usual care, mainly attributed to reduced hospitalization expenditures and travel costs [20].”
BackgroundUsing telehealth for heart failure: Barriers, pitfalls and nursing service models
Crundall-Goode, A., & Goode, K. M. (2014) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2014.9.8.396 · Cited by 19 · see citing works
“Telehealth service evaluations are often poorly organised (Polisena et al, 2010) with few focusing on the economic benefits (Seto, 2008).”
BackgroundThe Impact of Perioperative Remote Patient Monitoring on Clinical Staff Workflows: Scoping Review
León, M. A., Pannunzio, V., & Kleinsmann, M. S. (2022) · JMIR Human Factors · doi:10.2196/37204 · Cited by 19 · see citing works
Godden, D., & King, G. (2011) · Primary Care Respiratory Journal · doi:10.4104/pcrj.2011.00063 · Cited by 19 · see citing works
“Asthma Register Median (Range) 270 (97-602) 206 (135-333) 377 (142-674) 169 (52-708) 162 (30-455) 45 (7-291) Total Cases 4,952 674 2,724 2,274 4,359 2,839 17,822”
Gemignani, V., Bianchini, E., Faita, F., Lionetti, V., Campan, M., Recchia, F. A., Picano, E., & Bombardini, T. (2010) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2009.02684.x · Cited by 19 · see citing works
López‐Liria, R., López-Villegas, A., Enebakk, T., Thunhaug, H., Lappegård, K. T., & Catalán-Matamoros, D. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16112001 · Cited by 19 · see citing works
“It has been established in the recently published HRS (Heart Rhythm Society) consensus document that TM tenders a magnificent opportunity to enhance the efficiency of clinics and enable continuous monitoring of the functioning of the device and clinical status of patients and supported adherence to disease management…”
BackgroundBisson, L. J., Kluczynski, M. A., Lindborg, C. M., Rauh, M. A., DiPaola, M. J., Haider, M. N., & Pavlesen, S. (2021) · JAAOS Global Research and Reviews · doi:10.5435/jaaosglobal-d-21-00046 · Cited by 19 · see citing works
Effectiveness of a Cloud-Based Telepathology System in China: Large-Sample Observational Study
He, X., Wang, L., Wang, L., Gao, J., Cui, F., Ma, Q., Zhang, W., Wang, L., Zhai, Y., & Zhao, J. (2021) · Journal of Medical Internet Research · doi:10.2196/23799 · Cited by 18 · see citing works
Engaging telehealth to drive value-based urology
Modi, P. K., Portney, D. S., Hollenbeck, B. K., & Ellimoottil, C. (2018) · Current Opinion in Urology · doi:10.1097/mou.0000000000000508 · Cited by 16 · see citing works
Grustam, A. S., Vrijhoef, H. J., Koymans, R., Hukal, P., & Severens, J. L. (2017) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-017-0541-2 · Cited by 16 · see citing works
“[13] found that 30–50% of hypertensive patients were willing to pay at least $20 per month (CHF patients were willing to pay even more), while Seto [15] found that 55% of heart-failure patients were willing to pay $20, and 19% were willing to pay $40.”
BackgroundGjeka, R., Patel, K., Reddy, C., & Zetsche, N. (2021) · Health Informatics Journal · doi:10.1177/14604582211030959 · Cited by 16 · see citing works
“10 The quantity of cardiology research examining the impact of eHealth on such outcomes as prevention, early detection, treatment, stabilization, and self-management has blossomed over the last decade.”
BackgroundChallenges in Implementing a Pediatric Cardiovascular Home Telehealth Project
Black, A. K., Sadanala, U. K., Mascio, C. E., Hornung, C. A., & Keller, B. B. (2014) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2013.0343 · Cited by 16 · see citing works
Wearable Technologies and Telehealth in Care Management for Chronic Illness
Zhu, X., & Cahan, A. (2015) · Health informatics · doi:10.1007/978-3-319-20765-0_22 · Cited by 16 · see citing works
“Applied to heart failure patients, home monitoring reduced costs of hospital admissions [ 31 ] in one study, and in another, despite initial excess costs, substantial long term cost savings were found [ 47 ].”
BackgroundPatient Empowerment and New Citizen Roles through Telehealth Technologies - The Early Stage
Clemensen, J., Denning, A., Craggs, M. A., & Rasmussen, J. (2011) · University of Southern Denmark Research Portal (University of Southern Denmark) · Cited by 16 · see citing works
Londral, A., Azevedo, S., Dias, P., Ramos, C., Santos, J., Martins, F., Silva, R., Semedo, H., Vital, C., Gualdino, A., et al. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08073-4 · Cited by 15 · see citing works
“It also allows for a reduction of costs, both for the patient (hospital commutes and consultations) and the hospital (patients’ transportation, treatment of complications, and complementary diagnostic exams) [16].”
BackgroundUtilization of Home Telemonitoring in Patients 75 Years of Age and Over with Complex Heart Failure
Lemay, G., Azad, N. A., & Struthers, C. (2013) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x12473917 · Cited by 13 · see citing works
Over Half of Family Medicine Residency Program Directors Report Use of Telehealth Services
Moore, M. A., Jetty, A., & Coffman, M. (2018) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2018.0134 · Cited by 12 · see citing works
“4 In addition, telehealth could potentially alleviate disparities in access to care and help address issues of physician availability.”
Quality of Life in Heart Patients Receiving Telerehabilitation: An Overview with Meta-Analyses
Arian, M., Valinejadi, A., & Soleimani, M. (2022) · Iranian Journal of Public Health · doi:10.18502/ijph.v51i11.11157 · Cited by 12 · see citing works
“While HRQOL and all its dimensions have been significantly increased in HF patients using Mobile Phone-Based Telemonitoring-MPBT after 6 months (10).”
Simulation model for cost estimation of integrated care concepts of heart failure patients
Schröttner, J., & Lassnig, A. (2013) · Health Economics Review · doi:10.1186/2191-1991-3-26 · Cited by 12 · see citing works
“The systematic search from Seto also found articles, where co-payments by the patients would be accepted to access telemedicine service instead of travelling to the physician [11].”
BackgroundIntroduction of a telemonitoring service for patients affected by Chronic Heart Failure
Masella, C., Zanaboni, P., Borghi, G., Castelli, A., Marzegalli, M., & Tridico, C. (2009) · IEEE International Conference on e-Health Networking, Applications and Services (Healthcom) · doi:10.1109/health.2009.5406189 · Cited by 11 · see citing works
Arian, M., Valinejadi, A., & Soleimani, M. (2022) · Iranian Journal of Public Health · doi:10.18502/ijph.v51i7.10086 · Cited by 10 · see citing works
“Cost Saving Ten reviews reported that technology use significantly reduced cost saving as compared to routine care (1, 16, 28, 36, 39, 40, 43, 47, 49, 57).”
BackgroundSmart cities and smart health: Innovations in home medical devices for efficient healthcare delivery
Cai, T., Ma, J., & Ge‐Zhang, S. (2025) · Results in Engineering · doi:10.1016/j.rineng.2025.105739 · Cited by 11 · see citing works
Donati, M., Bacchillone, T., Fanucci, L., Saponara, S., & Costalli, F. (2013) · Journal of Computer Networks and Communications · doi:10.1155/2013/781620 · Cited by 9 · see citing works
“It provides a reduction in mortality, hospital readmissions, and lengths of hospital stays, and in general increases patient satisfaction [12–14].”
BackgroundIsaranuwatchai, W., Redwood, O., Schauer, A., Meer, T. V., Vallée, J., & Clifford, P. (2018) · JMIR Cardio · doi:10.2196/10319 · Cited by 10 · see citing works
“3% [2], and in a study by Scalvini et al to be approximately 10% [10].”
BackgroundResultGaps in the systematic reviews of the telemedicine field
Bahaadinbeigy, K., Kanagasingam, Y., & Wootton, R. (2010) · Journal of Telemedicine and Telecare · doi:10.1258/jtt.2010.100505 · Cited by 9 · see citing works
Automated weight monitoring in chronic heart failure: the excluded majority
Johnston, G., & Weatherburn, G. C. (2010) · Journal of Telemedicine and Telecare · doi:10.1258/jtt.2010.004007 · Cited by 9 · see citing works
Diagnostic tools in respiratory medicine (Review)
GEORGAKOPOULOU, V. E., Spandidos, D. A., & Corlăteanu, A. (2025) · Biomedical Reports · doi:10.3892/br.2025.1990 · Cited by 8 · see citing works
“Monitoring ranges from simple pulse oximetry systems, which transmit oxygen levels to a hospital physician during exacerbations, to complex health informatics systems (93,94).”
Adapting Health Systems for an Aging World: Policy Innovations and Global Strategies
Wheatley, M. C. (2024) · Premier journal of public health. · doi:10.70389/pjph.100010 · Cited by 8 · see citing works
“41 Wearable Health Monitoring Devices.”
Lapão, L. V. (2015) · Israel Journal of Health Policy Research · doi:10.1186/s13584-015-0036-5 · Cited by 8 · see citing works
Mapping Telemedicine Efforts: Surveying Regional Initiatives in Denmark
Kierkegaard, P. (2015) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2014.0123 · Cited by 8 · see citing works
Telemedicine: A new rise of hope to animal health care sector-A Review
Devi, S., Singh, R., Ghasura, R. S., Sharma, M. K., & Sharma, M. C. (2015) · Agricultural Reviews · doi:10.5958/0976-0741.2015.00018.5 · Cited by 8 · see citing works
“…diseases (Gaikwad and Warren 2009), telemonitoring proved to be rewarding in heart failure patients by reducing travel time, hospital admissions and constant monitoring of such critical condition (Seto, 2008), home telehealth for chronic conditions was found to be cost saving (Tran et al., 2008).”
BackgroundA study of home telehealth diffusion among US home healthcare agencies using system dynamics
Kılınç, M. S., & Milburn, A. B. (2016) · IIE Transactions on Healthcare Systems Engineering · doi:10.1080/19488300.2016.1195461 · Cited by 8 · see citing works
Bombardini, T., Gemignani, V., Bianchini, E., Pasanisi, E., Pratali, L., Pianelli, M., Faita, F., Giannoni, M., Arpesella, G., Sicari, R., et al. (2009) · Cardiovascular Ultrasound · doi:10.1186/1476-7120-7-21 · Cited by 8 · see citing works
Telemonitoring: Criteria for a Sustainable Implementation
Weinhold, I., Gastaldi, L., & Häckl, D. (2014) · Springer eBooks · doi:10.1007/978-3-319-12178-9_24 · Cited by 8 · see citing works
“, for cardiovascular conditions (Seto 2008)—due to reduced hospitalizations, readmissions or emergency-department visits and decreased times spent by health professionals in visiting patients and/or traveling (Rojas and Gagnon 2008).”
BackgroundVoigt, J. D., & Mosier, M. C. (2012) · Congestive Heart Failure · doi:10.1111/chf.12017 · Cited by 7 · see citing works
Many Canadians Feel Healthcare Needs Are Not Being Met
Sibley, L. M., & Glazier, R. H. (2010) · Healthcare Quarterly · doi:10.12927/hcq.2010.21808 · Cited by 7 · see citing works
“Decentralized service delivery can also be implemented to reduce travel time from patients' homes to healthcare services and to decrease associated out-of-pocket costs (Roberts et al. 2002; Seto 2008).”
Background
- Authors
- Seto, E.
- Affiliations
- University Health Network (CA)
- Corresponding author
- Seto, Emily
- ORCID
- Seto, Emily
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2008-09
- Volume
- 14
- Issue
- 7
- Pages
- 679-686
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- OpenAlex
- W1996071954
- Cited by
- 156
- References
- 32
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 5 · 2023: 2 · 2022: 12 · 2021: 8 · 2020: 6 · 2019: 4 · 2018: 12 · 2017: 6 · 2016: 7 · 2015: 14 · 2014: 10 · 2013: 17 · 2012: 17
- FWCI
- 1.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Telemedicine Journal and e-Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- heart failure, remote patient monitoring, cost comparison, usual care, hospital costs, hospital readmission, travel cost, willingness to pay, telemedicine, health care costs
- MeSH terms
- Canada, Heart Failure, Humans, Monitoring, Physiologic, Ontario, Cost Savings, Health Care Costs, Telemedicine
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