International Journal of Technology Assessment in Health Care



GENERAL ESSAYS

Telemedicine in pediatric and perinatal cardiology: Economic evaluation of a service in English hospitals


Robin Dowie a1, Hema Mistry a1, Tracey A. Young a2, Gwyn C. Weatherburn a3, Helena M. Gardiner a4, Michael Rigby a4, Giselle V. Rowlinson a5 and Rodney C. G. Franklin a6
a1 Brunel University
a2 University of Sheffield
a3 Buckinghamshire Chilterns University College
a4 Imperial College and Royal Brompton & Harefield NHS Trust
a5 Royal Brompton & Harefield NHS Trust
a6 National Heart & Lung Institute and Royal Brompton & Harefield NHS Trust

Abstract

Objectives: Pediatric cardiology has an expanding role in fetal and pediatric screening. The aims of this study were to observe how district hospitals use a pediatric telecardiology service, and to compare the costs and outcomes of patients referred to specialists by means of this service or conventionally.

Methods: A telemedicine service was set up between a pediatric cardiac center in London and four district hospitals for referrals of second trimester women, newborn babies, and older children. Clinicians in each hospital decided on the role for their service. Clinical events were audited prospectively and costed, and patient surveys were conducted.

Results: The hospitals differed in their selection of patient groups for the service. In all, 117 telemedicine patients were compared with 387 patients seen in London or in outreach clinics. Patients selected for telemedicine were generally healthier. For all patients, the mean cost for the initial consultation was £411 for tele-referrals and £277 for conventional referrals, a nonsignificant difference. Teleconsultations for women and children were significantly more expensive because of technology costs, whereas for babies, ambulance transfers were much more costly. After 6-months follow-up, the difference between referral methods for all patients was nonsignificant (telemedicine, £3,350; conventional referrals, £2,172), and nonsignificant within the patient groups.

Conclusions: Telemedicine was perceived by cardiologists, district clinicians, and families as reliable and efficient. The equivocal 6-month cost results indicate that investment in the technology is warranted to enhance pediatric and perinatal cardiology services.


Key Words: Costs and cost analysis; Heart defects; Congenital; Outpatients; Perinatal care; Telemedicine.