Prehospital Telemedicine Electrocardiogram Triage for a Regional Public Emergency Medical Service: Is It Worth It? A Preliminary Cost Analysis

Abstract

Background: Telemedicine has been shown to improve quality of health-care delivery in several fields of medicine; its cost-effectiveness, however, is still a matter of debate. Hypothesis: Pre-hospital telemedicine electrocardiogram triage for regional public emergency medical service may reduce costs. Methods: An economic evaluation (cost analysis) was performed from the perspective of regional health-care system. Patients enrolled in the study and considered for cost analysis were those who called the local emergency medical service (EMS; dialing 1-1-8) during 2012 and underwent prehospital field triage with a telemedicine electrocardiogram (ECG) in the case of suspected acute cardiac disease (acute coronary syndrome, arrhythmia). The prehospital ECGs were read by a remote cardiologist, available 24/7. Cost savings associated with this method were calculated by subtracting the cost of prehospital triage with telemedicine support from the cost of conventional emergency department triage (ECG and consultation by a cardiologist). Results: During 2012, the regional EMS performed 109 750 ECGs by telemedicine support. The associated total cost for the regional health-care system was ¤1 833 333, with a ¤16.70 cost per single ECG/consultation. Given the cost of similar conventional emergency department treatment from a regional rate list of ¤24.80 to ¤55.20, the savings was ¤8.10 to ¤38.40 per ECG/consultation (total savings, ¤891 759.50 to ¤4 219 379.50). The cost for ruling out an acute cardiac disease was ¤25.30; for a prehospital diagnosis of cardiovascular disease, ¤49.20. With 629 prehospital diagnoses of ST-elevation myocardial infarction and reported reductions in mortality thanks to prehospital diagnosis deduced from prior studies, 69 lives per year presumably could be saved, with a cost per quality-adjusted life year gained of ¤1927, ¤990/¤ − 2508 after correction for potential savings.Conclusions: Prehospital EMS triage with telemedicine ECG in patients with suspected acute cardiac disease may reduce health-care costs.

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

“…The first was a cost analysis from the perspective of a regional healthcare system. 172 It was based on the costs incurred by all patients who called the local emergency service in 2012 and had a pre-hospital triage for those with suspected acute cardiac disease (n = 109,750 Another cost analysis of implantable defibrillators was based on an RCT (n = 200). 174 Patients with implantable defibrillators with wireless transmission were randomized between remote monitoring and conventional care and were followed up for 16 months.…”

Telemedicine for cardiovascular disease continuum: A position paper from the Italian Society of Cardiology Working Group on Telecardiology and Informatics

“…Nevertheless, recent evidence shows some potential cost reduction associated with the implementation of telemedicine support. A cost per quality-adjusted life year gain of €1927 was calculated in a regional registry for pre-hospital electrocardiogram diagnosis of ST-elevation acute myocardial infarction [60]. Similarly, an 83$ individual cost saving per year was figured in another emergency setting using telemedicine support [61].…”

In China women uphold half of the sky, but only a quarter of them received reperfusion therapy for acute coronary syndrome

“…The positive effect of pre-hospital ECG on the outcome of patients with ACS has been repeatedly confirmed in several recent studies reported from around the world [46][47][48][49], including China [50][51][52].…”