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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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“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]
In the citing paper
“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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“Several studies have shown that home monitoring can reduce significantly the number of hospital readmissions in congestive heart failure (CHF) patients [1], [2].”
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“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
“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].”
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“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
“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].”
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Anthony, C. A., Lawler, E. A., Glass, N. A., McDonald, K., & Shah, A. S. (2017) · HAND · doi:10.1177/1558944716672201 · Cited by 22
“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
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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
“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
“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
Godden, D., & King, G. (2011) · Primary Care Respiratory Journal · doi:10.4104/pcrj.2011.00063 · Cited by 19
“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
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 22
“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 25
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
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 17
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
“[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
“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
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
“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
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
“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
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
“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
“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
“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
Arian, M., Valinejadi, A., & Soleimani, M. (2022) · Iranian Journal of Public Health · doi:10.18502/ijph.v51i7.10086 · Cited by 10
“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
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
“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
“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
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
Diagnostic tools in respiratory medicine (Review)
Georgakopoulou, V., Spandidos, D. A., & Corlăteanu, A. (2025) · Biomedical Reports · doi:10.3892/br.2025.1990 · Cited by 12
“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
“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
Mapping Telemedicine Efforts: Surveying Regional Initiatives in Denmark
Kierkegaard, P. (2015) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2014.0123 · Cited by 10
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
“…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 9
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
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
“, 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
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
“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
Metadata
- 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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