Key result
Prehospital telemedicine ECG triage for suspected acute cardiac disease resulted in savings of €8.10 to €38.40 per ECG/consultation compared to conventional emergency department triage.
Why the study?
Does prehospital telemedicine ECG triage reduce costs compared to conventional emergency department triage in patients with suspected acute cardiac disease?
Observational (n=109,750)
Does prehospital telemedicine ECG triage reduce costs compared to conventional emergency department triage in patients with suspected acute cardiac disease?
Effect estimate: savings of €8.10 to €38.40
Prehospital telemedicine ECG triage for suspected acute cardiac disease is associated with significant cost savings for the regional healthcare system compared to conventional emergency department triage.
May support regional cost savings with prehospital ECG triage; leaves open generalizability and outcome impact.
BACKGROUND: Telemedicine has been shown to improve quality of health-care delivery in several fields of medicine; its cost-effectiveness, however, is still a matter of debate. HYPOTHESIS: Pre-hospital telemedicine electrocardiogram triage for regional public emergency medical service may reduce costs. METHODS: An economic evaluation (cost analysis) was performed from the perspective of regional health-care system. Patients enrolled in the study and considered for cost analysis were those who called the local emergency medical service (EMS; dialing 1-1-8) during 2012 and underwent prehospital field triage with a telemedicine electrocardiogram (ECG) in the case of suspected acute cardiac disease (acute coronary syndrome, arrhythmia). The prehospital ECGs were read by a remote cardiologist, available 24/7. Cost savings associated with this method were calculated by subtracting the cost of prehospital triage with telemedicine support from the cost of conventional emergency department triage (ECG and consultation by a cardiologist). RESULTS: During 2012, the regional EMS performed 109 750 ECGs by telemedicine support. The associated total cost for the regional health-care system was €1 833 333, with a €16.70 cost per single ECG/consultation. Given the cost of similar conventional emergency department treatment from a regional rate list of €24.80 to €55.20, the savings was €8.10 to €38.40 per ECG/consultation (total savings, €891 759.50 to €4 219 379.50). The cost for ruling out an acute cardiac disease was €25.30; for a prehospital diagnosis of cardiovascular disease, €49.20. With 629 prehospital diagnoses of ST-elevation myocardial infarction and reported reductions in mortality thanks to prehospital diagnosis deduced from prior studies, 69 lives per year presumably could be saved, with a cost per quality-adjusted life year gained of €1927, €990/€ - 2508 after correction for potential savings. CONCLUSIONS: Prehospital EMS triage with telemedicine ECG in patients with suspected acute cardiac disease may reduce health-care costs.
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Brunetti et al. (2014) conducted an observational in Suspected acute cardiac disease (n=109,750). Prehospital telemedicine electrocardiogram triage vs. Conventional emergency department triage was evaluated on Cost savings per single ECG/consultation (savings of €8.10 to €38.40). Prehospital telemedicine ECG triage for suspected acute cardiac disease resulted in savings of €8.10 to €38.40 per ECG/consultation compared to conventional emergency department triage.
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