Radiology services for remote communities: cost minimisation study of telemedicine

Abstract Objectives : To determine the social costs of providing a rural population with radiology services under three different systems: the existing system (a small x ray unit at the remote site and all other examinations at the nearest radiology department (the host site)); a teleradiology system (most examinations at the remote site and more advanced examinations at the host site); and all examinations at the host site. Design : Cost minimisation study. Setting : Primary health care in a remote community in Norway. Subjects : A randomly selected sample (n=597) of all patients (n=1793) having radiological examinations in 1993. Main outcome measures : Annual direct medical costs, direct non-medical (travel) costs, and indirect costs (lost production) of the three options. Results : After exclusion of costs common to the three systems the direct medical, direct non-medical, and indirect costs of the three options were, respectively, £9000, £51 000, and £31 500 (total £91 500) for the existing system; £108 000, £2000, and £13 500 (total £123 500) for the teleradiology option; and £0, £75 000, and £42 000 (£117 000 in total) for the “all at host” option. Sensitivity analyses indicated that the existing system is the least costly option except when lost leisure is valued as highly as lost production. Conclusion : The teleradiology option did not seem to be cost saving in the study community. Such systems, however, may be justified on the grounds of equity of access and quality of care. Key messages Few, if any, studies of the cost effectiveness of this technology have been published This study indicates that in remote primary health care, teleradiology is not less costly than conventional technologies Teleradiology may be justified as a means to increase equity in access to high quality health care in remote communities The subject calls for further studies in other countries