Economic and Environmental Impact of Digital Health App Video Consultations in Follow-up Care for Patients in Orthopedic and Trauma Surgery in Germany: Randomized Controlled Trial

J Med Internet Res. 2022 Nov 4. doi: 10.2196/42839. Online ahead of print.

ABSTRACT

BACKGROUND: 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 healthcare, 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 healthcare systems.

OBJECTIVE: 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 the economic and the environmental impact of video consultations, taking into account the goal of carbon neutrality for the German healthcare system by 2030.

METHODS: We conducted a prospective randomized controlled trial in a German university hospital 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 costs, time costs, and production losses. Examination of the environmental impact comprised the emissions of greenhouse gases, carbon monoxides, volatile hydrocarbons, nitrogen oxides, 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.

RESULTS: Data from 52 patients indicated that, from the patients' point of view, telemedicine helped to reduce travel costs, time costs, and production losses, resulting in mean cost savings of €76.52 per video consultation when compared with a face-to-face consultation. In addition, emissions of 11.248 kg of greenhouse gases, 0.070 kg of carbon monoxides, 0.011 kg of volatile hydrocarbons, 0.028 kg of nitrogen oxides, and 0.00004 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.

CONCLUSIONS: We presented the first comprehensive analysis of economic and environmental effects of telemedicine in the follow-up care of orthopedic and trauma surgery patients 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 utilization of digital health during and beyond the COVID-19 pandemic, providing decision-makers with data for both the economic and the 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.

CLINICALTRIAL: German Clinical Trials Register DRKS00023445; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023445.

PMID:36333935 | DOI:10.2196/42839