Ana Paula Beck da Silva Etges1, Bruna Stella Zanotto2, Karen Brasil Ruschel2, Rodolfo Souza da Silva3, Matheus Oliveira4, Taís de Campos Moreira5, Felipe Cezar Cabral5, Aline Lutz de Araujo6, Roberto Nunes Umpierre7, Marcelo Rodrigues Gonçalves3, Erno Harzheim3, Carisi Anne Polanczyk8. 1. National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil; Graduate Epidemiology Program, School of Medicine, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil. 2. National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil. 3. Graduate Epidemiology Program, School of Medicine, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; Núcleo de Telessaúde, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil. 4. School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil; Núcleo de Telessaúde, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil. 5. Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil. 6. Núcleo de Telessaúde, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo (USP), São Paulo, São Paulo, Brazil. 7. Núcleo de Telessaúde, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil. 8. National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil; Graduate Epidemiology Program, School of Medicine, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; Núcleo de Telessaúde, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: cpolanczyk@hcpa.edu.br.
Abstract
OBJECTIVES: Advances in telemedicine offer a unique opportunity to expand access to the health system. Nevertheless, few studies have described the impact of telediagnosis implementation on health and economic outcomes. METHODS: An ophthalmology telediagnosis service (TeleOftalmo) was compared with traditional face-to-face care provided by the Brazilian public health system. For both groups, utility data were collected at 2 time points using the Visual Function Questionnaire-Utility Index instrument from interviews with 536 patients. The cost per patient encounter was analyzed according to the time-driven activity-based costing. Value analyses were conducted to ascertain whether and how telemedicine service has the potential to generate cost savings for the health system. RESULTS: Visual function-related quality of life did not differ significantly between TeleOftalmo and face-to-face care groups. Using the current model, the telemedicine service assisted an average of 1159 patients per month at a median cost per telediagnosis of Int$97 (interquartile range, Int$82-Int$119) versus Int$77 (interquartile range, Int$75-Int$80) for face-to-face care. If the telemedicine service was redesigned, considering the opportunities for improvement identified, it could operate at a cost of Int$53 per telediagnosis (a 31% cost savings) and could serve 3882 patients per month. CONCLUSIONS: This study demonstrates the potential value of a telemedicine service. There was no difference in patient-perceived utility between a telediagnostic ophthalmology service and face-to-face care by an eye specialist. TeleOftalmo has the potential to be a cost-saving strategy for the Brazilian health system and could be a template for implementation of telediagnostic services in other regions.
OBJECTIVES: Advances in telemedicine offer a unique opportunity to expand access to the health system. Nevertheless, few studies have described the impact of telediagnosis implementation on health and economic outcomes. METHODS: An ophthalmology telediagnosis service (TeleOftalmo) was compared with traditional face-to-face care provided by the Brazilian public health system. For both groups, utility data were collected at 2 time points using the Visual Function Questionnaire-Utility Index instrument from interviews with 536 patients. The cost per patient encounter was analyzed according to the time-driven activity-based costing. Value analyses were conducted to ascertain whether and how telemedicine service has the potential to generate cost savings for the health system. RESULTS: Visual function-related quality of life did not differ significantly between TeleOftalmo and face-to-face care groups. Using the current model, the telemedicine service assisted an average of 1159 patients per month at a median cost per telediagnosis of Int$97 (interquartile range, Int$82-Int$119) versus Int$77 (interquartile range, Int$75-Int$80) for face-to-face care. If the telemedicine service was redesigned, considering the opportunities for improvement identified, it could operate at a cost of Int$53 per telediagnosis (a 31% cost savings) and could serve 3882 patients per month. CONCLUSIONS: This study demonstrates the potential value of a telemedicine service. There was no difference in patient-perceived utility between a telediagnostic ophthalmology service and face-to-face care by an eye specialist. TeleOftalmo has the potential to be a cost-saving strategy for the Brazilian health system and could be a template for implementation of telediagnostic services in other regions.