Estimated Indirect Cost Savings of Using Telehealth Among Nonelderly Patients With Cancer

Abstract

ImportancePatients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing substantial challenges to delivering cancer care and resulting in important changes in care-delivery models, including the rapid adoption of telehealth.ObjectiveTo estimate patient travel, time, and cost savings associated with telehealth for cancer care delivery.Design, Setting, and ParticipantsAn economic evaluation of cost savings from completed telehealth visits from April 1, 2020, to June 30, 2021, in a single-institution National Cancer Institute–Designated Comprehensive Cancer Center. All patients aged 18 to 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. Data were analyzed from April 2020 to June 2021.Main Outcomes and MeasuresThe main outcome was estimated patient cost savings from telehealth, which included 2 components: costs of travel (defined as roundtrip distance saved from car travel) and potential loss of productivity due to the medical visit (defined as loss of income from roundtrip travel plus loss of income from in-person clinic visits). Two different models with a combination of 2 different mileage rates ($0.56 and $0.82 per mile) and census tract–level median hourly wages were used.ResultsThe study included 25 496 telehealth visits with 11 688 patients. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits. Median (IQR) age was 55.0 (46.0-61.0) years among the telehealth visits, with 15 663 visits (61.4%) by women and 18 360 visits (72.0%) by Hispanic non-White patients. According to cost models, the estimated mean (SD) total cost savings ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile. For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean (SD) total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile.Conclusions and RelevanceIn this economic evaluation, telehealth was associated with savings in patients time and travel costs, which may reduce the financial toxicity of cancer care. Expansion of telehealth oncology services may be an effective strategy to reduce the financial burden among patients with cancer.

Patient and caregiver experience with telehealth for surgical cancer care: A qualitative study

“…Our findings suggest positive experiences with telehealth for preanesthesia and postoperative visits among patients and caregivers of various cancer types (e.g., gastrointestinal, genitourinary, and gynecologic). Common benefits of telehealth included time and cost savings associated with travel, which have been previously documented in the literature in cancer care 13,16,19,20,22,27–31 . Since surgical recovery can involve fatigue, one surgery‐specific benefit was allowing surgical patients to avoid having to travel while fatigued and in recovery.…”

“…Common benefits of telehealth included time and cost savings associated with travel, which have been previously documented in the literature in cancer care. 13,16,19,20,22,[27][28][29][30][31] Since surgical recovery can involve fatigue, one surgery-specific benefit was allowing surgical patients to avoid having to travel while fatigued and in recovery. Similar sentiments were expressed in another study on postoperative visits among patients with cancer.…”

Demographic disparities in receipt of care at a comprehensive cancer center

“…19 Increased telehealth visits at one NCICC resulted in significant cost-savings and reduction of financial toxicity for patients seeking cancer care. 20 As these approaches to care delivery become a more routine part of cancer care, it will be important to evaluate the impact on access to guideline-based care or clinical trials for populations that have been less likely to access care at NCICCs (e.g., racial and ethnic minorities, those living further away from NCICCs). Additionally, Medicare and Medicaid patients were more likely to be non-analytic cases compared to patients with private/managed insurance, possibly reflecting delays in insurance approvals of referrals.…”

“…Some data suggests that satellite clinics can increase healthcare access for different racial/ethnic groups including Native Americans and Asians, although less of a benefit was seen for Hispanic and Black patients 19 . Increased telehealth visits at one NCICC resulted in significant cost‐savings and reduction of financial toxicity for patients seeking cancer care 20 . As these approaches to care delivery become a more routine part of cancer care, it will be important to evaluate the impact on access to guideline‐based care or clinical trials for populations that have been less likely to access care at NCICCs (e.g., racial and ethnic minorities, those living further away from NCICCs).…”

Racial Differences in Patient-Reported Access to Telehealth: An Important and Unmeasured Social Determinant of Health

“…Emerging data suggest that telehealth may reduce financial and transportation barriers for patients undergoing cancer treatment and can offer opportunities for clinicians to provide reassurance and emotional support for cancer survivors. [7][8][9] However, barriers to telehealth use and racial differences in access among patients with cancer have not been well described in the literature to date.…”