Digitization of Follow-Up Care in Orthopedic and Trauma Surgery With Video Consultations: Health Economic Evaluation Study From a Health Provider's Perspective

• Published in: Journal of medical Internet research Vol. 25; no. 1; p. e46714
• Main Authors: Muschol, Jennifer, Heinrich, Martin, Heiss, Christian, Hernandez, Alher Mauricio, Knapp, Gero, Repp, Holger, Schneider, Henning, Thormann, Ulrich, Uhlar, Johanna, Unzeitig, Kai, Gissel, Christian
• Format: Journal Article
• Language: English
• Published: Canada Journal of Medical Internet Research 25.12.2023; Gunther Eysenbach MD MPH, Associate Professor; JMIR Publications
• Subjects: Acute Care Surgery; Aftercare; Analysis; Clinical decision making; Clinical research; Clinical trials; Cost analysis; Cost-Benefit Analysis; COVID-19; Decision making; Digitization; Economic aspects; Employees; GDP; Gross Domestic Product; Health care expenditures; Health status; Humans; Long term; Medical care, Cost of; Original Paper; Outpatient treatment; Pandemics; Patients; Physicians; Productivity; Questionnaires; Savings; Sensitivity analysis; Shoulder injuries; Stakeholders; Suitability; Surgery; Telemedicine; Trauma surgery; Uptake; Germany; United States > US; telemedicine; digital health; orthopedic; personnel costs; utility; economic evaluation; trauma surgery; video consultations; productivity gains; health economics
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/46714

Recommendations for health care digitization as issued with the Riyadh Declaration led to an uptake in telemedicine to cope with the COVID-19 pandemic. Evaluations based on clinical data are needed to support stakeholders' decision-making on the long-term implementation of digital health. This health economic evaluation aims to provide the first German analysis of the suitability of video consultations in the follow-up care of patients in orthopedic and trauma surgery, investigate the financial impact on hospital operations and personnel costs, and provide a basis for decisions on digitizing outpatient care. We conducted a randomized controlled trial that evaluated video consultations versus face-to-face consultations in the follow-up care of patients in orthopedic and trauma surgery at a German university hospital. We recruited 60 patients who had previously been treated conservatively or surgically for various knee or shoulder injuries. A digital health app and a browser-based software were used to conduct video consultations. The suitability of telemedicine was assessed using the Telemedicine Satisfaction Questionnaire and the EQ-5D-5L questionnaire. Economic analyses included average time spent by physician per consultation, associated personnel costs and capacities for additional treatable patients, and the break-even point for video consultation software fees. After 4 withdrawals in each arm, data from a total of 52 patients (telemedicine group: n=26; control group: n=26) were used for our analyses. In the telemedicine group, 77% (20/26) of all patients agreed that telemedicine provided for their health care needs, and 69% (18/26) found telemedicine an acceptable way to receive health care services. In addition, no significant difference was found in the change of patient utility between groups after 3 months (mean 0.02, SD 0.06 vs mean 0.07, SD 0.17; P=.35). Treatment duration was significantly shorter in the intervention group (mean 8.23, SD 4.45 minutes vs mean 10.92, SD 5.58 minutes; P=.02). The use of telemedicine saved 25% (€2.14 [US $2.35]/€8.67 [US $9.53]) in personnel costs and increased the number of treatable patients by 172 annually, assuming 2 hours of video consultations per week. Sensitivity analysis for scaling up video consultations to 10% of the hospital's outpatient cases resulted in personnel cost savings of €73,056 (US $ 80,275.39) for a senior physician. A total of 23 video consultations per month were required to recoup the software fees of telemedicine through reduced personnel costs (break-even point ranging from 12-38 in the sensitivity analysis). Our study supports stakeholders' decision-making on the long-term implementation of digital health by demonstrating that video consultations in the follow-up care of patients in orthopedic and trauma surgery result in cost savings and productivity gains for clinics with no negative impact on patient utility. German Clinical Trials Register DRKS00023445; https://drks.de/search/en/trial/DRKS00023445.