Methods for Economic Evaluation of Telemedicine

Telemedicine is increasingly being incorporated into routine clinical practice; however, its widespread adoption requires rigorous economic justification.Scaling-up decisions are complicated by significant fixed and incremental costs of digital infrastructure, heterogeneity in clinical and organizational effects, and strong context dependence, which collectively limit both the internal validity of estimates and the transferability of results across health systems and payers.This paper examines the main approaches used to assess the economic value of telemedicine as a medical technology and clarifies the decision questions each approach aims to answer.It compares costeffectiveness analysis and cost-feasibility analysis, which quantify gains in effectiveness in natural units and quality-adjusted life years, respectively, with additional approaches such as budget impact analysis for assessing the affordability and feasibility of implementation, cost-benefit analysis for assessing monetized outcomes, and cost-impact analysis for multidimensional outcome reporting.Particular attention is paid to methodological requirements that determine the quality of research, including a clearly defined perspective and time horizon, comprehensive identification and measurement of digital and organizational costs, appropriate modeling of long-term disease trajectories and service delivery pathways, transparent consideration of uncertainty, and consideration of equity and access limitations to digital technologies.Based on this foundation, minimum criteria for the quality of effectiveness evaluations are outlined, enabling decision-makers to consistently interpret telemedicine evaluation results and reliably use them in reimbursement, procurement, and scale-up policies.