JMIR Publications

ABSTRACT

Background:

In recent years, the rapid development of information and communications technology, through innovations in video-conferencing solutions and the emergence of connected medical devices, has contributed to expanding the scope of application and expediting the development of telemedicine.

Objective:

In this study, we evaluate the use of teleconsultations for specialist consultations at hospitals in terms of costs, resource consumption and patient travel time. The key feature of our evaluation framework is the combination of an economic evaluation through a cost analysis and a performance evaluation through a discrete-event simulation (DES) approach.

Methods:

Three datasets were used to obtain detailed information on the characteristics of patients, the characteristics of patients’ residential locations, and usage of telehealth stations. A propensity score matching procedure was applied in the economic evaluation. To identify the best scenarios for reaping the full benefits from teleconsultations, various scenarios depicting different population types and deployment strategies were explored in the DES. Associated break-even levels were calculated.

Results:

The results of the cost evaluation shed light on a higher cost for the teleconsultation group, mainly induced by higher volumes of (tele)consultations per patient and the substantial initial investment in teleconsultation equipment. Sensitivity analysis suggests heterogeneous economic profitability levels within subpopulations and based on the intensity of use of teleconsultation solutions. In fact, the DES model results show that teleconsultations could be a cost-saving strategy in some cases, depending on the population characteristics, amortization speed of telehealth equipment, and locations of telehealth stations.

Conclusions:

The use of teleconsultations has the potential to lead to a major organizational change in the health care system in the near future. Nevertheless, its performance is strongly related to the context and deployment strategy.