Cost-effectiveness of telehealth-delivered nutrition interventions: a systematic review of randomized controlled trials

Abstract

Context: Telehealth-delivered nutrition interventions are effective in practice; however, limited evidence exists regarding their cost-effectiveness.

Objective: To evaluate the cost-effectiveness of telehealth-delivered nutrition interventions for improving health outcomes in adults with chronic disease.

Data sources: PubMed, CENTRAL, CINAHL, and Embase databases were systematically searched from database inception to November 2021. Included studies were randomized controlled trials delivering a telehealth-delivered diet intervention conducted with adults with a chronic disease and that reported on cost-effectiveness or cost-utility analysis outcomes.

Data extraction: All studies were independently screened and extracted, and quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

Data analysis: All extracted data were grouped into subcategories according to their telehealth modality and payer perspective, and were analyzed narratively.

Results: Twelve randomized controlled trials comprising 5 phone-only interventions, 3 mobile health (mHealth), 2 online, and 1 each using a combination of phone-online or phone-mHealth interventions, were included in this review. mHealth interventions were the most cost-effective intervention in all studies. Across all telehealth interventions and cost analyses from health service perspectives, 60% of studies were cost-effective. From a societal perspective, however, 33% of studies reported that the interventions were cost-effective. Of the 10 studies using cost-utility analyses, 3 were cost saving and more effective, making the intervention dominant, 1 study reported no difference in costs or effectiveness, and the remaining 6 studies reported increased cost and effectiveness, meaning payers must decide whether this falls within an acceptable willingness-to-pay threshold for them. Quality of study reporting varied with between 63% to 92%, with an average of 77% of CHEERS items reported.

Conclusion: Telehealth-delivered nutrition interventions in chronic disease populations appear to be cost-effective from a health perspective, and particularly mHealth modalities. These findings support telehealth-delivered nutrition care as a clinically beneficial, cost-effective intervention delivery modality.

Keywords: cost; cost-effectiveness; diet; digital health; economic; mHealth; nutrition; telehealth.

Figure 1

Flowchart of the search results and included studies.

Figure 2

Proportional breakdown of the cost-effectiveness according to health service (n = 10) and societal (n = 3) perspectives.

Figure 3

Cost-effectiveness studies (cost-utility analyses only) mapped on the cost-effectiveness plane with incremental costs and quality-adjusted life-years (n = 10). The arrow for Graves et al represents a true point estimate that is beyond the scale of this figure. Abbreviation: QOL, quality of living.

Figure 4

Cost-effectiveness of all telehealth modalities regardless of payer perspective.