Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 Feb 19;21(2):e11330.
doi: 10.2196/11330.

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

Astrid Buvik #  1 , Trine S Bergmo  2 , Einar Bugge  3 , Arvid Smaabrekke  1 , Tom Wilsgaard  3   4 , Jan Abel Olsen  4   5
Affiliations
Randomized Controlled Trial

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

Astrid Buvik et al. J Med Internet Res. .

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).

Keywords: QALY; cost-effectiveness analysis; economic evaluation; orthopedics; outpatients; randomized controlled trial; remote consultation; telemedicine; videoconferencing.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Norway and the area where the study patients were recruited and location of the University Hospital of North Norway and Regional Medical Center (inserted).
Figure 2
Figure 2
Total annual costs of the teleorthopedic service including the Skype for Business alternative.
Figure 3
Figure 3
Cost per patient for base case and the Skype for Business alternative.
See this image and copyright information in PMC

References

    1. Ministry of Health and Care Services. 2011. Apr 8, [2018-01-03]. Meld. St. 16 (2010–2011). Report to the Storting (white paper). Summary — National Health and Care Services Plan https://www.regjeringen.no/en/dokumenter/meld.-st.-16-2010-2011/id639794/)
    1. Patient travels. 2018. [2018-03-20]. Compensation of patient travels https://helsenorge.no/rettigheter/pasientreiser/reimbursement-of-patient... .
    1. The Norwegian Directorate of Health. 2015. [2017-01-17]. Data from the specialist health services (Samdata 2014) https://helsedirektoratet.no/publikasjoner/samdata-spesialisthelsetjenesten .
    1. Pastora-Bernal JM, Martín-Valero R, Barón-López FJ, Estebanez-Pérez MJ. Evidence of benefit of telerehabitation after orthopedic surgery: a systematic review. J Med Internet Res. 2017 Dec 28;19(4):e142. doi: 10.2196/jmir.6836. http://www.jmir.org/2017/4/e142/ v19i4e142 - DOI - PMC - PubMed
    1. Bashshur RL, Shannon G, Krupinski EA, Grigsby J. Sustaining and realizing the promise of telemedicine. Telemed J E Health. 2013 May;19(5):339–45. doi: 10.1089/tmj.2012.0282. http://europepmc.org/abstract/MED/23289907 - DOI - PMC - PubMed

Publication types

Associated data