Cost-Effectiveness of Telemedicine in Remote Orthopedic Consultations: Randomized Controlled Trial

Abstract

Background Telemedicine consultations using real-time videoconferencing has the potential to improve access and quality of care, avoid patient travels, and reduce health care costs. Objective The aim of this study was to examine the cost-effectiveness of an orthopedic videoconferencing service between the University Hospital of North Norway and a regional medical center in a remote community located 148 km away. Methods An economic evaluation based on a randomized controlled trial of 389 patients (559 consultations) referred to the hospital for an orthopedic outpatient consultation was conducted. The intervention group (199 patients) was randomized to receive video-assisted remote orthopedic consultations (302 consultations), while the control group (190 patients) received standard care in outpatient consultation at the hospital (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 showed that using videoconferencing for orthopedic consultations in the remote clinic costs less than standard outpatient consultations at the specialist hospital, as long as the total number of patient consultations exceeds 151 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 consultations needed to break even was 183. Conclusions This study showed that providing video-assisted orthopedic consultations to a remote clinic in Northern Norway, rather than having patients travel to the specialist hospital for consultations, is cost-effective from both a societal and health sector perspective. This conclusion holds as long as the activity exceeds 151 and 183 patient consultations per year, respectively. Trial Registration ClinicalTrials.gov NCT00616837; https://clinicaltrials.gov/ct2/show/NCT00616837 (Archived by WebCite at http://www.webcitation.org/762dZPoKX)

Telehealth for Upper Extremity Conditions: Perceptions of the Patient and Provider

“…Additional reports have shown cost savings about travel and societal expenses with the implementation of remote orthopaedic consultations. 17 , 18 A systematic review by Torre-Diaz et al looked at the cost utility and cost effectiveness of telemedicine across all fields and found that a relative scarcity of the literature is seen on this topic. Some cost effectiveness studies reported that telemedicine was able to reduce costs, but not all supported this notion.…”

SARS-CoV-2-Pandemie und ihre Auswirkungen auf Orthopädie und Unfallchirurgie: „Booster“ für die Telemedizin

“…Außerdem sind Sensoren bereits so kostengünstig erhältlich, dass ihre Anwendung in der Überwachung von Therapien und Rehabilitationen realistisch ist. Die Vernetzung mit webbasierten Anwendungen macht den 1,82, p = 0,0030); das Konfidenzintervall lag jedoch innerhalb der Nicht-Minderwertigkeitsspanne [7][8][9]. Auch bei weiteren sekundären Endpunkten gab es keine signifikanten Unterschiede.…”

“…Die Dauer der Konsultation betrug 20,9 min in der Standardsprechstundengruppe und 20,5 mininderTelemedizingruppe [7][8][9]. Auch hinsichtlich der OP-Indikationen (17 % in der Standardgruppe und 11 % in der Telemedizingruppe) und Komplikationen (21 % in der Standardgruppe und 17 % in der Telemedizingruppe) bestanden keine signifikanten Unterschiede [7][8][9]. Es bestand kein Unterschied in den "patient reported outcome measures" (PROM).…”

“…Der EQ-5D Index Score betrug 0,77 in der konventionellen und 0,75 in der Telemedizingruppe (p = 0,42) [8]. Die Kosten der Videosprechstunde waren nach 151 Patientenkonsultationen geringer als die der konventionellen Sprechstunde [9].…”

“…Die Autoren zogen die Schlussfolgerung, dass sich videounterstützte Konsultationen für orthopädische Patienten eignen [7][8][9]. Junge Patienten mit Knieproblemen (sporttraumatologische Diagnosen) und Schulterpatienten wurden jedoch von der Studie ausgeschlossen, da hier nach Ansicht der Autoren funktionelle Untersuchungen (Kniestabilität, Schultertests) eine große Rolle in der Diagnostik spielen [7][8][9].…”