TELEMEDICINE COST SAVINGS ARE CONDITIONAL RATHER THAN AUTOMATIC: A SYSTEMATIC REVIEW OF ECONOMIC EVIDENCE AND ITS IMPLICATIONS FOR REMOTE AND UNDERSERVED HEALTH SYSTEMS
Author(s)
Marcia Athayde Moreira, Doctor of Controllership and Accounting1, Everaldo Marcelo Souza da Costa, Doctor of Administration2, Jorge Brantes Ferreira, Ph.D.3, Danyllo Cezar Kaway Neves da Cruz, Master of Accounting1, Edgar José Pereira Dias, Doctor of Administration2, Fernanda Leao Ramos, Ph.D.4.
1Master's Program in Accounting, Federal University of Pará, Belém, Brazil, 2Master's and Doctorate Program in Administration, University of the Amazon, Belém, Brazil, 3Business Administration, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil, 4Business Administration, FGV EBAPE, Rio de Janeiro, Brazil.
1Master's Program in Accounting, Federal University of Pará, Belém, Brazil, 2Master's and Doctorate Program in Administration, University of the Amazon, Belém, Brazil, 3Business Administration, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil, 4Business Administration, FGV EBAPE, Rio de Janeiro, Brazil.
OBJECTIVES: Telemedicine is widely promoted as a cost-reducing route to expanding healthcare access in remote regions, yet payers lack a clear account of whether, and under what conditions, savings materialize. This study systematically reviewed the economic evidence on telemedicine to establish when digital care reduces costs, when it does not, and which factors separate the two, for settings such as the Brazilian Amazon.
METHODS: A systematic review followed PRISMA guidance across Scopus, SciELO, and Spell, scoped to business, management, economics, and finance sources from 2021 onward plus one citation-search record. From 95 records, 16 empirical studies (primary-data field or case studies; open access; organizational focus) were content-analyzed into two themes: cost, sustainability, and financial efficiency; and implementation, regulation, and service organization.
RESULTS: The evidence was divergent. Most studies documented savings through avoided hospitalizations, reduced travel, and efficient clinical time: remote monitoring lowered hospitalization costs for heart-failure and oncology patients across several European systems, and remote specialist second opinions saved over US$8,000 per case while cutting surgeries 40%. Others found no savings or higher costs: one teleconsultation program raised per-patient costs roughly 63% through defensive over-testing, ophthalmology teleconsultation showed no economic advantage, and nurse triage saved money at state but not municipal level.
CONCLUSIONS: Telemedicine is not inherently cost-saving, and treating it as such in value assessments risks overstating returns. Whether digital care reduces costs turns on one distinction: savings concentrate where telemedicine substitutes for hospitalizations, travel, and in-person visits, and costs rise where it is additive, adding consultations or defensive testing on top of usual care. Sufficient volume, integration with care processes, and sound management push services toward substitution. For payers and health technology assessment in underserved settings such as the Amazon, advancing the UN's Sustainable Development Goal 3, the substitution-versus-addition balance indicates where investment returns value.
METHODS: A systematic review followed PRISMA guidance across Scopus, SciELO, and Spell, scoped to business, management, economics, and finance sources from 2021 onward plus one citation-search record. From 95 records, 16 empirical studies (primary-data field or case studies; open access; organizational focus) were content-analyzed into two themes: cost, sustainability, and financial efficiency; and implementation, regulation, and service organization.
RESULTS: The evidence was divergent. Most studies documented savings through avoided hospitalizations, reduced travel, and efficient clinical time: remote monitoring lowered hospitalization costs for heart-failure and oncology patients across several European systems, and remote specialist second opinions saved over US$8,000 per case while cutting surgeries 40%. Others found no savings or higher costs: one teleconsultation program raised per-patient costs roughly 63% through defensive over-testing, ophthalmology teleconsultation showed no economic advantage, and nurse triage saved money at state but not municipal level.
CONCLUSIONS: Telemedicine is not inherently cost-saving, and treating it as such in value assessments risks overstating returns. Whether digital care reduces costs turns on one distinction: savings concentrate where telemedicine substitutes for hospitalizations, travel, and in-person visits, and costs rise where it is additive, adding consultations or defensive testing on top of usual care. Sufficient volume, integration with care processes, and sound management push services toward substitution. For payers and health technology assessment in underserved settings such as the Amazon, advancing the UN's Sustainable Development Goal 3, the substitution-versus-addition balance indicates where investment returns value.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE149
Topic
Economic Evaluation, Medical Technologies
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas