Telemedicine service achieves net savings in travel costs

A study of the Townsville Cancer Centre's teleoncology service over almost five years has found that it can achieve net savings through major reductions in travel costs for patients and specialists, which could then be redirected into enhancing rural health resources.

The study, published in today's Medical Journal of Australia (MJA),, was aimed at assessing whether there was a cost benefit to using a telemedicine model of cancer care compared with the usual model of care.

It assessed 605 teleoncology consultations with 147 patients over 56 months, which the authors estimate had a total cost of $442,276.

However, they also estimated that the travel expenses avoided by using video consultations totalled $762,394, a figure that included the costs of travel for patients, escorts and specialists, aeromedical retrievals and some accommodation costs.

“This resulted in a net saving of $320,118,” the researchers found. The team included Darshit Thaker, a medical oncologist at Townsville Hospital's Department of Medical Oncology and its director, Sabe Sabesan, who is also clinical dean of the Townsville Clinical School, part of James Cook University.

The other authors are Richard Monypenny, an adjunct associate professor of JCU's School of Business, and the Cancer Council of Australia's CEO Ian Olver.

The researchers write that the Townsville Cancer Centre (TCC) set up a teleoncology service for its rural satellite sites in 2007, including Mt Isa, which is 900km from Townsville. In this study, the vast majority of patients were from Mt Isa but several used the service from Proserpine, Hughenden, Winton, Doomadgee and three sites in the Gulf of Carpentaria.

“The Townsville teleoncology model involves videoconference sessions in which medical oncologists consult with patients who may be supported during the videoconferences by local health care professionals,” the researchers write.

“Referrals to the teleoncology service are managed by a coordinator at TCC. The need for local health care professionals to be present during videoconferences is determined by the complexity of the cases. This means that, in some cases, patients attend videoconferences alone.”

Costs included one-off equipment purchases, continuing maintenance costs and the salaries of a part-time service co-ordinator and a chemotherapy nurse in Mt Isa.

The savings were attributed to avoiding travel by patients and escorts to a tertiary centre; avoiding overnight accommodation for patients and escorts in Townsville; avoiding aeromedical retrievals; and avoiding travel by specialist oncologists.

“Seeing patients urgently by means of videoconferencing and advising the necessary management plan to local medical services avoided aeromedical retrieval of patients from satellite sites to the tertiary centre, thus representing further savings,” the researchers write.

“Finally, regular 3-weekly visits to satellite sites by a specialist oncologist became unnecessary. We based savings calculations for specialist travel and accommodation on the same prices used to calculate costs for patient travel and accommodation.”

Costs excluded from the calculations of costs and savings were the social cost of disruption to patient work routine, family routine and loss of income; indirect benefits, such as prevention of loss of wages by patients and relatives and reduction in workload at the home site; loss of time incurred by specialists during travel to the satellites and the cost of staff at the tertiary centre and in the six satellite sites, who were employed regardless of the teleoncology model.

The researchers write that while other studies have shown there are no or negligible savings by using telehealth compared to face-to-face consultations, this study and several others that concentrated on services covering vast distances did show cost savings.

“In our model, in Mt Isa, all the medical oncology services were able to be provided locally by telehealth, which avoided interhospital transfers and led to further cost savings. However, our findings may not be generalisable to models with smaller patient numbers and with patients travelling smaller distances.

“Since July 2011, more than 80% of our consultations have been eligible for a Medicare rebate by the Australian government. While we did not include this in our cost analysis, these rebates would provide further financial benefit to the hospital and health services from the telehealth model.”

Posted in Australian eHealth

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