title: Economic evaluation of web-based compared with in-person follow-up after total joint arthroplasty.
abstract: BACKGROUND
  We previously demonstrated the feasibility and clinical effectiveness of a web-based assessment following total hip or total knee arthroplasty. The purpose of the present study was to conduct an economic evaluation to compare a web-based assessment with in-person follow-up.
  
  
  METHODS
  Patients who had undergone total joint arthroplasty at least twelve months previously were randomized to complete a web-based follow-up or visit the clinic for the usual follow-up. We recorded travel costs and time associated with each option. We followed patients for one year after the web-based or in-person follow-up evaluation and documented any resource use related to the joint arthroplasty. We conducted cost analyses from the health-care payer (Ontario Ministry of Health and Long-Term Care) and societal perspectives. All costs are presented in 2012 Canadian dollars.
  
  
  RESULTS
  A total of 229 patients (118 in the web-based group, 111 in the usual-care group) completed the study. The mean cost of the assessment from the societal perspective was $98 per patient for the web-based assessment and $162 per patient for the usual method of in-person follow-up. The cost for the web-based assessment was significantly lower from the societal perspective (mean difference, $-64; 95% confidence interval [CI], $-79 to $-48; p < 0.01) and also from the health-care payer perspective (mean difference, $-27; 95% CI, $-29 to $-25; p < 0.01).
  
  
  CONCLUSIONS
  The web-based follow-up assessment had a lower cost per patient compared with in-person follow-up from both societal and health-care payer perspectives.
authors.affiliation: Faculty of Health Sciences, Elborn College, The University of Western Ontario, 1201 Western Road, London, ON N6G 1H1, Canada. E-mail address for J. Marsh: jmarsh2@uwo.ca. E-mail address for D. Bryant: dianne.bryant@uwo.ca.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Marsh
authors.affiliation: Centre for Excellence in Economic Analysis and Research, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada. E-mail address: hochj@smh.ca.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hoch
authors.affiliation: Faculty of Health Sciences, Elborn College, The University of Western Ontario, 1201 Western Road, London, ON N6G 1H1, Canada. E-mail address for J. Marsh: jmarsh2@uwo.ca. E-mail address for D. Bryant: dianne.bryant@uwo.ca.
authors.forename: Dianne
authors.initials: D
authors.lastname: Bryant
authors.affiliation: London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: steven.macdonald@lhsc.on.ca. E-mail address for D. Naudie: douglas.naudie@lhsc.on.ca. E-mail address for R. McCalden: richard.mccalden@lhsc.on.ca. E-mail address for J. Howard: james.howard@lhsc.on.ca. E-mail address for R. Bourne: robert.bourne@lhsc.on.ca. E-mail address for J. McAuley: james.mcauley@lhsc.on.ca.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: MacDonald
authors.affiliation: London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: steven.macdonald@lhsc.on.ca. E-mail address for D. Naudie: douglas.naudie@lhsc.on.ca. E-mail address for R. McCalden: richard.mccalden@lhsc.on.ca. E-mail address for J. Howard: james.howard@lhsc.on.ca. E-mail address for R. Bourne: robert.bourne@lhsc.on.ca. E-mail address for J. McAuley: james.mcauley@lhsc.on.ca.
authors.forename: Douglas
authors.initials: D
authors.lastname: Naudie
authors.affiliation: London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: steven.macdonald@lhsc.on.ca. E-mail address for D. Naudie: douglas.naudie@lhsc.on.ca. E-mail address for R. McCalden: richard.mccalden@lhsc.on.ca. E-mail address for J. Howard: james.howard@lhsc.on.ca. E-mail address for R. Bourne: robert.bourne@lhsc.on.ca. E-mail address for J. McAuley: james.mcauley@lhsc.on.ca.
authors.forename: Richard
authors.initials: R
authors.lastname: McCalden
authors.affiliation: London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: steven.macdonald@lhsc.on.ca. E-mail address for D. Naudie: douglas.naudie@lhsc.on.ca. E-mail address for R. McCalden: richard.mccalden@lhsc.on.ca. E-mail address for J. Howard: james.howard@lhsc.on.ca. E-mail address for R. Bourne: robert.bourne@lhsc.on.ca. E-mail address for J. McAuley: james.mcauley@lhsc.on.ca.
authors.forename: James
authors.initials: J
authors.lastname: Howard
authors.affiliation: London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: steven.macdonald@lhsc.on.ca. E-mail address for D. Naudie: douglas.naudie@lhsc.on.ca. E-mail address for R. McCalden: richard.mccalden@lhsc.on.ca. E-mail address for J. Howard: james.howard@lhsc.on.ca. E-mail address for R. Bourne: robert.bourne@lhsc.on.ca. E-mail address for J. McAuley: james.mcauley@lhsc.on.ca.
authors.forename: Robert
authors.initials: R
authors.lastname: Bourne
authors.affiliation: London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: steven.macdonald@lhsc.on.ca. E-mail address for D. Naudie: douglas.naudie@lhsc.on.ca. E-mail address for R. McCalden: richard.mccalden@lhsc.on.ca. E-mail address for J. Howard: james.howard@lhsc.on.ca. E-mail address for R. Bourne: robert.bourne@lhsc.on.ca. E-mail address for J. McAuley: james.mcauley@lhsc.on.ca.
authors.forename: James
authors.initials: J
authors.lastname: McAuley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011182:Postoperative Care / Q000191:economics* / Q000379:methods