Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany.
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany.
J Med Internet Res. 2022 Nov 24;24(11):e42839. doi: 10.2196/42839.
Following the Riyadh Declaration, digital health technologies were prioritized in many countries to address the challenges of the COVID-19 pandemic. Digital health apps for telemedicine and video consultations help reduce potential disease spread in routine health care, including follow-up care in orthopedic and trauma surgery. In addition to the satisfaction, efficiency, and safety of telemedicine, its economic and environmental effects are highly relevant to decision makers, particularly for the goal of reaching carbon neutrality of health care systems.
This study aims to provide the first comprehensive health economic and environmental analysis of video consultations in follow-up care after knee and shoulder interventions in an orthopedic and trauma surgery department of a German university hospital. The analysis is conducted from a societal perspective. We analyze both economic and environmental impacts of video consultations, taking into account the goal of carbon neutrality for the German health care system by 2030.
We conducted a prospective randomized controlled trial comparing follow-up care with digital health app video consultations (intervention group) to conventional face-to-face consultations in the clinic (control group). Economic impact included the analysis of travel and time costs and production losses. Examination of the environmental impact comprised the emissions of greenhouse gases, carbon monoxide, volatile hydrocarbons, nitrogen oxides, and particulates, and the calculation of environmental costs. Sensitivity analysis included calculations with a higher cost per ton of carbon dioxide equivalent, which gives equal weight to the welfare of present and future generations.
Data from 52 patients indicated that, from the patients' point of view, telemedicine helped reduce travel costs, time costs, and production losses, resulting in mean cost savings of €76.52 per video consultation. In addition, emissions of 11.248 kg of greenhouse gases, 0.070 kg of carbon monoxide, 0.011 kg of volatile hydrocarbons, 0.028 kg of nitrogen oxides, and 0.0004 kg of particulates could be saved per patient through avoided travel. This resulted in savings of environmental costs between €3.73 and €9.53 per patient.
We presented the first comprehensive analysis of economic and environmental effects of telemedicine in the follow-up care of patients in orthopedic and trauma surgery in Germany. Video consultations were found to reduce the environmental footprint of follow-up care; saved travel costs, travel time, and time costs for patients; and helped to lower production losses. Our findings can support the decision-making on the use of digital health during and beyond the COVID-19 pandemic, providing decision makers with data for both economic and environmental effects. Thanks to the pragmatic design of our study, our findings can be applied to a wide range of clinical contexts and potential digital health applications that substitute outpatient hospital visits with video consultations.
German Clinical Trials Register DRKS00023445; https://tinyurl.com/4pcvhz4n.
在《利雅得宣言》之后，许多国家将数字健康技术作为优先事项，以应对 COVID-19 大流行带来的挑战。用于远程医疗和视频咨询的数字健康应用程序有助于减少常规医疗保健中的潜在疾病传播，包括矫形和创伤外科的随访护理。除了远程医疗的满意度、效率和安全性外，其经济和环境影响对决策者也非常重要，特别是对于实现医疗保健系统碳中和的目标。
本研究旨在提供德国一所大学附属医院矫形和创伤外科部门中，膝关节和肩部手术后随访中视频咨询的首个全面的健康经济和环境分析。该分析从社会角度进行。我们分析了视频咨询的经济和环境影响，同时考虑到到 2030 年德国医疗保健系统实现碳中和的目标。
我们进行了一项前瞻性随机对照试验，比较了数字健康应用程序视频咨询（干预组）与传统的诊所面对面咨询（对照组）在随访护理中的效果。经济影响包括旅行和时间成本以及生产损失的分析。环境影响的检测包括温室气体、一氧化碳、挥发性碳氢化合物、氮氧化物和颗粒物的排放，以及环境成本的计算。敏感性分析包括使用更高的每吨二氧化碳当量成本的计算，这对当前和未来几代人的福利给予同等重视。
来自 52 名患者的数据表明，从患者的角度来看，远程医疗有助于降低旅行成本、时间成本和生产损失，使每位患者的平均视频咨询成本节省 76.52 欧元。此外，每位患者可避免旅行，从而节省 11.248 千克温室气体、0.070 千克一氧化碳、0.011 千克挥发性碳氢化合物、0.028 千克氮氧化物和 0.0004 千克颗粒物的排放，这也节省了每位患者 3.73 欧元至 9.53 欧元的环境成本。
我们提出了德国矫形和创伤外科患者随访中远程医疗的经济和环境影响的首个全面分析。视频咨询被发现可以减少随访护理的环境足迹；为患者节省了旅行成本、旅行时间和时间成本；并有助于降低生产损失。我们的研究结果可以为在 COVID-19 大流行期间和之后使用数字健康技术提供决策支持，为决策者提供经济和环境影响的数据。由于我们的研究设计具有务实性，我们的研究结果可以应用于广泛的临床环境和潜在的数字健康应用程序，这些应用程序可以用视频咨询替代门诊就诊。
德国临床试验注册处 DRKS00023445；https://tinyurl.com/4pcvhz4n。
