OBJECTIVES: For years, the evidence of telemedicine cost-effectiveness was scarce, explaining in part why this medical delivery remains low. We conducted a systematic review and regression analysis to determine: (1) the characteristics of telemedicine studies; (2) the determinants of economically efficient telemedicine interventions.

METHODS: We reviewed all published economic evaluations of telemedicine in Cochrane, Embase and Pubmed from 2008 to 2018. Articles were classified by two researchers (protocol available on PROSPERO). We constructed an exclusive dataset on the characteristics of selected articles, including: type of telemedicine intervention; medical field; indicators of the quality of the trial. The dataset was enriched using OECD data on medical density and socio-demographic controls at the country level. We explained the determinants of economically dominant telemedicine interventions using a multivariable logit model and estimated effects using odd-ratios.

RESULTS: We included 151 articles out of 2488 (acceptation rate: 6.1%). Most economic studies of our sample regard telemonitoring (67.5%), followed by teleconsultation (19.1%), teleassistance (10.8%) and tele-expertise (2.7%). Overall, they follow recommended guidelines: 85.3% are cost-effectiveness or cost-utility analysis, the median number of participants is 229, and 75.8% are randomised. 17.2% of included trials regard mental health interventions. 72.6% of these studies found that the telemedicine intervention dominated economically the control group. All things equal, cost-effectiveness of telemedicine is significantly negatively associated with medical density, and indicators of quality. We found no significant effect of the publication year, signifying that the nature of the evidence has not changed overtime.

CONCLUSIONS: In summary, articles with higher standards of economic evaluation are less likely to report a dominant intervention. However, published evidence has found that telemedicine is overall cost-effective, regardless of the medical field. The number of economic evaluations on telemedicine has grown significantly over the reviewed period. This should benefit public decision and increase recourse to telemedicine.