JMIR Publications

ABSTRACT

Background:

Telemedicine consultations using realtime videoconferencing has the potential to improve access and quality of care, avoid patient travels and reduce healthcare costs.

Objective:

The aim of this study was to examine the cost-effectiveness of an orthopaedic videoconferencing service between the University Hospital of North-Norway and a regional medical centre in a remote community located 148 km away.

Methods:

An economic evaluation based on a randomised controlled trial of 389 patients (557 consultations) referred to the hospital for an orthopaedic outpatient consultation was conducted 5 years after the intervention ended. Patients randomised to the intervention group received video-assisted remote orthopaedic consultations (n=302 consultations). Patient randomised to the control group received standard care in outpatient consultation at the hospital (n=257 consultations). A societal perspective was adopted for calculating costs. Health outcomes were measured as Quality Adjusted Life Years (QALYs) gained. Resource use and health outcomes were collected alongside the trial at baseline and at 12 months follow-up using questionnaires, patient charts and consultation records. These were valued using externally collected data on unit costs and QALY-weights. An extended sensitivity analysis was conducted to address the robustness of the results.

Results:

This study shows that using videoconferencing for orthopaedic consultations in the remote clinic costs less than standard outpatient consultations at the specialist hospital, as long as the total number of patient consultations exceed 158 per year. For a total workload of 300 consultations per year the annual cost savings amounted to €18,616. If costs were calculated from a health sector perspective, rather than a societal perspective, the number of consultation needed to break even was 193.

Conclusions:

The number of patients visiting the remote medical centre were much larger than the break even numbers. Thus, the telemedicine service investigated here is cost-effective, both from a societal and a health sector perspective. Clinical Trial: ClinicalTrials.gov identifier: NCT00616837. Due to organisational delays, the trial was registered on 22 January 2008. The specified study start date in ClinicalTrials.gov is November 2007.