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. Hypothesis 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 ε1 833 333, with a ε16.70 cost per single ECG/consultation. Given the cost of similar conventional emergency department treatment from a regional rate list of ε24.80 to ε55.20, the savings was ε8.10 to ε38.40 per ECG/consultation (total savings, ε891 759.50 to ε4 219 379.50). The cost for ruling out an acute cardiac disease was ε25.30; for a prehospital diagnosis of cardiovascular disease, ε49.20. 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 ε1927, ε990/ε - 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. © 2014 Wiley Periodicals, Inc.