Cost comparison analysis of a telemedical platform as amendment of aeromedical retrieval services in Australia

Kurzfassung

Introduction Aeromedical retrieval services (MedEvac) are an essential element of emergency medical services especially in rural areas, remote regions, off-shore and in extreme environments. Patients benefit from the timely access to health care. MedEvac operations are usually controlled and supervised in a coordination center. Specialists in the center validate the data provided in emergency calls and use it for a decision-making process to decide whether MedEvac is necessary or not. Telemedicine delivers health care services across distances. It can provide medical expertise to the point of care using e.g. video communication systems. Patient data and additional relevant information can be transmitted to medical experts in the coordination center or in hospitals improving the decision-making process. Aeromedical evacuation of employees or citizens is very expensive for companies or for the public health care system. Consequently a reduction of unnecessary evacuations could create a financial benefit for the sponsors. To determine the cost savings for a customer using telemedicine, a cost-comparison analysis (CCA) was carried out for Australia where aeromedical retrieval services are day-to-day business due to long distances and extreme environments. The main topic of the CCA is the comparison of aeromedical retrieval services with and without the amendment of telemedical services. Methods To determine the economic potential, a CCA was carried out using data on current costs and prospective financial benefits. Literature search: The most frequent illnesses and injuries in the oil and gas industry were determined in a query on PubMed. Articles published before 2008 were omitted to include only recent data. The publications had to be in the context of telemedicine. Articles on health economic evaluation in the field of telemedicine were identified as well. The articles should not have been published before 2002. Health economic evaluation: The cost-comparison analysis should identify the break-even when the amendment of telemedicine to aeromedical retrieval services provides a financial benefit to a customer. The average costs per hour of MedEvac of a service provider in Australia, the CareFlight Group Queensland, were calculated. Next, costs for a telemedical platform were estimated and included into a calculation that considers the potential avoidance of aeromedical retrieval. A telemedical platform fulfilling the requirements of an oil&gas company and providing telemedical services from physicians of 6 disciplines to 10 remote stations has been designed basing on equipment of the Scotty Group Austria GmbH. Scotty is providing their equipment e.g. for the Telemedical Networks of the German Armed Forces. The health economic evaluation assumes that the technology is used for 5 years before being renewed. Results The platform consists of a system located at the coordination center capable to link remote stations and medical experts (AUD 57,140), 6 systems located at different medical experts (AUD 120,000) and 10 portable systems located at the remote stations, e.g. offshore rigs (AUD 564,500). Total technology costs are AUD 741,640. Medical experts are paid on a flat-rate premium of AUD 2,000 per month. 6 experts x 60 months X AUD 2,000 = AUD 720,000 Costs for the staff at the coordination center is estimated as 1 person at AUD 150,000 per year AUD 150,00 x 5 years = AUD 750,000 720,000 (experts) + 750,000 (staff) + 740,000 (technology) =AUD 2,210,000 Overhead costs for communication and premises and running costs are estimated and determined at 10% of the total system costs = AUD 221,000. Total service costs are AUD 2,431,000 or AUD 243,100 per remote station within 5 years. This corresponds to yearly costs per remote customer station of AUD 48,620 Costs for medical evacuation: In the business year 2012 to 2013 CareFlight Group Queensland performed 575 lifesaving helicopter missions with average costs of AUD 12,000 per four hours flight time. That results in costs of AUD 7,187,500 for lifesaving helicopter missions in one business year. Costs per hour are AUD 3,000. Literature shows that some 14% of the MedEvac were not necessary. For CareFlight this would be some 80 helicopter missions of average 4 flight hours, a total of 320 flight hours, or 960.000 per year. But CareFlight doesn’t exclusively serve offshore rigs or mines but other customers like the public sector as well. Thus the calculation bases on costs per hour of evacuation which are AUD 3,000 to be able to calculate a break-even point for the remote station from the customers point of view. The costs for a remote station amortize after 48,620/3,000 per hour = 16.2 hours of avoided flights per year. 16.2 hours (to be saved) / 14 x 100=118 hours (MedEvac overall) A telemedical service for remote locations where aeromedical retrieval is day-to-day business in medical emergencies provides an economic benefit if the average number of hours paid for retrieval exceeds 118. Basing on the assumed rates the break-even is reached when a remote site pays 118 hours x AUD 3,000= AUD 354,000 or more per year for aeromedical retrieval. Conclusions Recent analysis showed that telemedicine is able to prevent unnecessary helicopter evacuations due to the additional information provided in comparison to emergency calls via telephone or radio. Offering telemedical emergency assessment to improve the decision making process on aeromedical retrieval can be a unique selling proposition (USP) for MedEvac providers as they avoid unnecessary evacuation and thus convince customers to contract them. A business model could for instance base on a pay per use billing. But to calculate the appropriate rates it is of interest how often the service would be used for non-critical cases of illnesses and injuries as well to deliver medical expert support quicker. Oil, gas or mining industry benefits from the avoidance of aeromedical evacuations as much as from a prompter medical care for their employees avoiding disease- or injury-related absenteeism even in non-critical cases. Telemedicine thus can create a win-win situation for both providers and their customers if the break-even is reached or surpassed.   Results The analysis of current primary care revealed that the first aid on offshore rigs is often provided by non-medical staff, being trained in advanced first aid. Currently the first aiders receive additional medical expertise from occupational health physicians via telephone. Recent analysis showed that telephone descriptions by the non-medical staff are not sufficient and result in unnecessary evacuation. The analysis of the diagnostic capabilities of telemedicine indicated that the first aider and a physician could perform a detailed assessment of the patient’s health status. The use of video communication offers the possibility to see and speak with the patient on-site. Moreover, the usage of medical devices delivers additional medical data, supports diagnostics and accelerates the initiation of an appropriate treatment recommended by the remote expert.