title: Economic Evaluation of Pediatric Telemedicine Consultations to Rural Emergency Departments.
abstract: Comprehensive economic evaluations have not been conducted on telemedicine consultations to children in rural emergency departments (EDs).
  
  
  
  We conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective.
  
  
  
  We built a decision model with parameters from primary programmatic data, national data, and the literature. We performed a base-case cost-effectiveness analysis (CEA), a probabilistic CEA with Monte Carlo simulation, and ROI estimation when CEA suggested cost-saving. The CEA was based on program effectiveness, derived from transfer decisions following telemedicine and telephone consultations.
  
  
  
  The average cost for a telemedicine consultation was $3641 per child/ED/year in 2013 US dollars. Telemedicine consultations resulted in 31% fewer patient transfers compared with telephone consultations and a cost reduction of $4662 per child/ED/year. Our probabilistic CEA demonstrated telemedicine consultations were less costly than telephone consultations in 57% of simulation iterations. The ROI was calculated to be 1.28 ($4662/$3641) from the base-case analysis and estimated to be 1.96 from the probabilistic analysis, suggesting a $1.96 return for each dollar invested in telemedicine. Treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED.
  
  
  
  Telephone and telemedicine consultations were not randomly assigned, potentially resulting in biased results.
  
  
  
  From a health care payer perspective, telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving (base-case and more than half of Monte Carlo simulation iterations) or cost-effective compared with telephone consultations.
authors.affiliation: Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
authors.forename: Nikki H
authors.initials: NH
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
authors.forename: Madan
authors.initials: M
authors.lastname: Dharmar
authors.affiliation: Department of Public Health Sciences, University of California, Davis, CA, USA (BKY, JPL)
authors.forename: Byung-Kwang
authors.initials: BK
authors.lastname: Yoo
authors.affiliation: Department of Public Health Sciences, University of California, Davis, CA, USA (BKY, JPL)
authors.forename: J Paul
authors.initials: JP
authors.lastname: Leigh
authors.affiliation: Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)|Department of Emergency Medicine, University of California, Davis, CA, USA (NK)
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
authors.affiliation: Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)|Department of Internal Medicine, University of California, Davis, CA, USA (PSR)
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
authors.affiliation: Department of Family Practice and Community Medicine, University of California, Davis, CA, USA (TSN)
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
authors.affiliation: Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
mesh_terms: D000208:Acute Disease / Q000191:economics* / Q000628:therapy*; D002648:Child; D003362:Cost-Benefit Analysis / Q000191:economics*; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D009010:Monte Carlo Method; D010372:Pediatrics / Q000191:economics*; D019114:Remote Consultation / Q000191:economics*; D019035:Rural Health Services / Q000191:economics*; D013689:Telephone / Q000191:economics; D014947:Wounds and Injuries / Q000191:economics* / Q000628:therapy*
keywords: cost-effectiveness; economic evaluation; emergency medicine; pediatrics; rural health; telemedicine