Prehospital telemedicine electrocardiogram triage for a regional public emergency medical service: is it worth it? A preliminary cost analysis.
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.


OBJECTIVE
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.
Department of Cardiology, University of Foggia, Foggia, Italy.
Natale Daniele
ND
Brunetti
Giulia
G
Dellegrottaglie
Claudio
C
Lopriore
Giuseppe
G
Di Giuseppe
Luisa
L
De Gennaro
Saverio
S
Lanzone
Matteo
M
Di Biase
D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004562:Electrocardiography / Q000191:economics*; D004632:Emergency Medical Services / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D007558:Italy / Q000453:epidemiology; D009203:Myocardial Infarction / Q000175:diagnosis; D019057:Quality-Adjusted Life Years; D012041:Regional Medical Programs / Q000191:economics; D013686:Telemetry / Q000191:economics*; D014218:Triage / Q000191:economics / Q000379:methods*