2002

Economic evaluation of telemedicine. The case studies that cannot be generalized

Economic evaluation of telemedicine. The case studies that cannot be generalized

Trine S Bergmo, Norwegian Centre for Telemedicine, University Hospital of Tromsoe.

Economic evaluation serves to identify, measure value and compare the consequences of different courses of actions in terms of both their costs and benefits. Such information will aid authorities when they determine cost-effective resource allocation. Economic evaluation of telemedicine has been comparing the costs of telemedicine to the avoided costs of conventional methods. Telemedicine has in most cases assumed to have no effect on the patients health outcome, but is just a method of providing the same service in a different manner. The main benefit has been avoided travels. Economic research on telemedicine is highly situation-specific and results can seldom be generalized from one telemedicine setting to another.

It has been carried out economic analyses of several telemedicine services in northern Norway. Some of the applications were cost-effective while others were not. A teleradiology service, an ENT-telemedicine service (ear, nose and throat) and a teledermatology service have been analysed and all three applications were cost-effective. An off-line transmission of retina images to check for diabetic retinopathy does not yet have sufficient patient workload to break even. Another teleradiology service analysed in a scenario study reached the same conclusion. Neither of these two studies found telemedicine to be cost-effective due to relatively high investment costs.

Another application that have been analysed is the use of telemedicine to support haemodialysis management at a local dialysis unit. This telemedicine service was expensive and not cost-effective compared to the alternative method. The service however, provided benefits for the patients. They avoided travels and follow-up stays at the central hospital and they experienced improved dialogue with the specialist.

Low-cost telemedicine using pre-recorded still images or sound files in an electronic referral might be an economic viable option for some rural clinics. This however, will depend on the annual patient workload and the distance to the specialist. The use of pre-recorded heart sound for children with a heart murmur has too low potential patient workload to break even. The use of still image teledermatology is more likely to be cost-effective in several rural areas due to higher workloads and with that more avoided travels.

Whether telemedicine is cost-effective or not depends on several situation-specific factors. The most important one is the potential patient workload. Other such as the magnitude of the cost elements, whether a visiting service is an available option or not and the distance from the rural site to the secondary care centre will also influence the result. Decisions about whether to implement telemedicine based on financial arguments must be made in the light of local circumstances. Adopting large scale telemedicine services at this stage must therefore be justified on arguments beyond general cost-effectiveness.

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