Evaluation of: Henderson C, Knapp M, Fernández J-L et al. Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ 346, f1035 (2013). Telehealth has the potential to improve the management of chronic health conditions but there are still limited data on its effectiveness and cost-effectiveness in routine practice. A questionnaire study nested within a pragmatic randomized controlled trial estimated costs and outcomes for management of patients in England who had heart failure, chronic obstructive pulmonary disease, or diabetes. Patients received telehealth support and usual care or usual care only. The study perspective was that of the health system. Incremental cost per quality-adjusted life year of telehealth when added to usual care was £79,000. In this setting, telehealth had a low probability of being a cost-effective addition to standard care for patients with the chronic conditions.