Prehospital Telemedicine Electrocardiogram Triage for a Regional Public Emergency Medical Service: Is It Worth It? A Preliminary Cost Analysis

AbstractBackgroundTelemedicine 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.HypothesisPre‐hospital telemedicine electrocardiogram triage for regional public emergency medical service may reduce costs.MethodsAn 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).ResultsDuring 2012, the regional EMS performed 109 750 ECGs by telemedicine support. The associated total cost for the regional health‐care system was €1 833 333, with a €16.70 cost per single ECG/consultation. Given the cost of similar conventional emergency department treatment from a regional rate list of €24.80 to €55.20, the savings was €8.10 to €38.40 per ECG/consultation (total savings, €891 759.50 to €4 219 379.50). The cost for ruling out an acute cardiac disease was €25.30; for a prehospital diagnosis of cardiovascular disease, €49.20. 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 €1927, €990/€ − 2508 after correction for potential savings.ConclusionsPrehospital EMS triage with telemedicine ECG in patients with suspected acute cardiac disease may reduce health‐care costs.