Cost effectiveness of telemedicine for the delivery of outpatient pulmonary care to a rural population
Cost effectiveness of telemedicine for the delivery of outpatient pulmonary care to a rural population
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DOI：
10.1089/15305620260353171
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发表时间：
2002-09-01
期刊：
影响因子：
--
通讯作者：
Maker, AH
中科院分区：
文献类型：
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作者：
Agha, Z;Schapira, RM;Maker, AH
本研究的目的是通过远程医疗确定门诊肺部亚专科会诊的成本效益。采用决策分析模型比较门诊远程医疗肺部会诊与替代治疗方法的成本效益。模型选项包括：(1)远程医疗，(2)常规护理（患者从远程站点到中心站点接受护理），以及(3)现场护理（患者在远程站点接受护理）。从密尔沃基和铁山退伍军人事务医疗中心（VAMC）远程肺项目收集了为期1年的成本和效果数据。成本效益分析是从社会角度进行的。计算平均成本-效果比和增量成本-效果比，并进行敏感性分析。与常规护理（每位患者每年585美元）和现场护理（每位患者每年1166美元）相比，发现远程医疗更具成本效益（每位患者每年335美元）。敏感性分析显示，远程医疗的成本效益对患者数量、远程医疗会诊成功率、远程医疗设备成本、远程医疗效用和分配给现场肺病医生的工作量百分比的变化敏感。远程医疗是一种具有成本效益的替代方案，可为获得亚专科服务有限的农村人口提供门诊肺部护理。远程医疗的成本效益与三个主要因素有关：成本分担，即足够的病人数量和在各种临床用户之间共享远程医疗基础设施；远程医疗在患者效用和成功临床咨询方面的有效性；通过降低病人丧失生产力的成本，间接节省了成本。
The objective of this study was to determine the cost effectiveness of outpatient pulmonary subspecialty consultations via telemedicine. A decision-analytic model was used to compare the cost effectiveness of providing outpatient telemedicine pulmonary consultations with alternative treatment methods. Model options included: (1) telemedicine, (2) routine care (patients travel from a remote site to the hub site to receive care), and (3) on-site care (patients receive care at the remote site). Cost and effectiveness data from the Milwaukee and Iron Mountain Veterans Affairs Medical Centers (VAMC) telepulmonary program were collected for a period of 1 year. The cost-effectiveness analysis was conducted from a societal perspective. Average and incremental cost-effectiveness ratios were calculated together with sensitivity analysis. Telemedicine was found to be more cost effective ($335 per patient/year) compared to routine care ($585 per patient/year) and on-site care ($1166 per patient/year). Sensitivity analysis revealed that cost effectiveness of telemedicine was sensitive to changes in the values for the number of patients, probability of successful telemedicine consultation, telemedicine equipment cost, utility of telemedicine, and percentage effort assigned to the on-site pulmonary physician. Telemedicine is a cost-effective alternative for the delivery of outpatient pulmonary care for rural populations with limited access to subspecialty services. Cost effectiveness of telemedicine is related to three major factors: cost sharing, i.e., adequate patient volume and sharing of telemedicine infrastructure amongst various clinical users; effectiveness of telemedicine in terms of patient utility and successful clinical consultations; and indirect cost savings accrued by decreasing cost of patients' lost productivity.