The insightful study of Montori et al. (1) raises the question of whether telecare can close the gap between the necessary and frequent interventions by health care professionals in order to lower the HbA1c of patients. We would like to comment on the control group and meta-analysis in their study.
Telecare can be embedded into different achievable scenarios, where the left-most cornerstone considers a control group and where conventional care means no intervention (A). The right-most cornerstone is to replace face-to-face interventions by telecare with the same frequency and quality as in the control group (B). In reality, the typical group defining “conventional care” would be situated between these two cornerstones. Due to regional differences, the private situation, and, particularly, the distance to the next specialist, the patients would not be able to achieve the necessary frequency of face-to-face visits that they would if the doctor’s office were next door (C).
In a comparative study, medical outcome (HbA1c) and costs would be different depending on whether strategy A or B or something in between was adopted. A cost-effectiveness study is particularly mandatory in strategy B, where the primary outcome parameter would be cost and the secondary parameter HbA1c.
In a randomized cost-effectiveness study (2), we adopted strategy B in order to isolate the effect of telecare and not any effect attributable to the frequency of interventions. A similar study by Chase et.al (3) is also situated closely to strategy B. Both studies came to the conclusion that telecare can save costs while maintaining the quality of care (HbA1c).
In another recent study (4), we tried to adopt an approach that better simulates a patient’s “real-life” (C) by having the patients in the control group being educated first in hospital and then returning to their private practitioners. We believe that due to the different goals of the studies and the different control groups, a meta-analysis would ultimately draw equivocal or false conclusions.
In conclusion, we would suggest adding the method of whether a cost-effectiveness analysis or an outcome analysis has been performed to a further meta-analysis in telecare. However, the use of excellent tools such as intention-to-treat analysis and the high degree of transparency makes the report of Montori et al. groundbreaking and a critical starting point for further studies in this field.
