The Effect of Telehealth on Cost of Health Care During the COVID-19 Pandemic: A Systematic Review

Background: As the COVID-19 public health emergency (PHE) altered delivery of health care, alternate forms of health care delivery were adopted. The usage of telehealth expanded during the PHE to reduce exposure to COVID-19, which provides the opportunity to understand how expanded telehealth access affected costs of care. The objective of this work was to evaluate the association between telehealth adoption and health care-related costs during the COVID-19 PHE. Methods: We conducted a systematic review by searching PubMed, Embase, Cochrane Central Register of Controlled Trials, and CINAHL from database inception to May 26, 2023. In June 2023, we also searched Telehealth.HHS.gov and the Rural Health Research Gateway. We sought to identify studies across three main search domains: telehealth, COVID-19, and cost. We analyzed costs based on an economic perspective: patient, health care payer, and health care sector. Results: Out of 8,557 studies screened, 12 studies met the inclusion criteria. Studies had high heterogeneity in telehealth modality and cost perspectives. Included studies had, on average, a moderate risk of bias and lacked standardized outcomes that would have aided in across-study comparisons. We found that the COVID-19 PHE was associated with an increase in spending on telehealth services and decreased patient health care costs, which limited changes in monthly total health care spending. Results were variable, however, based on the telehealth application studied. Conclusions: Telehealth may be associated with cost savings from a patient perspective and from a broader health care sector perspective. Future research should focus on the role of integrated telehealth applications and long-term costs using the societal perspective.