ABSTRACT
Objective To assess the cost of launching telemedicine services by Peking Union Medical College Hospital (PUMCH) during coronavirus disease 2019 pandemic. Methods The patients using telemedicine services were enrolled during the period of pilot run from February 10th to April 15th, 2020. The study was done from the social perspective. A decision-tree model was constructed to compare the costs between telemedicine services and conventional clinical services for outpatients. The main outcome was measured as incre- mental cost-effective ness ratios (ICER). Sensitivity analysis was conducted by using one-way sensitivity analysis. Results During a period of forty-seven days, the online fever clinic was applied 3055 person-times(2070 patients) and the online outpatient clinic were applied 36 549 person-times(20 467 patients). On average, 44 febrile cases/d and 435 nonfebrile cases/d were reduced in the outpatient clinic. It helped to reduce roughly 1/4 (febrile) and 1/5(nonfebrile) of total numbers of the patients in the outpatient clinic during the peak period of the epidemic. If calculated according to the actual free-of-charge condition, the ICER was -64.7 yuans/person-time. If the actual cost of each consultant of telemedicine service was estimated according to the level of outpatient-service fee, the ICER was -5.5 yuans/person-time. The results of sensitivity analysis showed that the main factors affecting the ICERs were transportation cost, lost wages, and the efficiency of telemedicine services. Conclusions Launching telemedicine services helped to relieve the pressure at the outpatient clinics, and has the potential to provide significant cost saving compared to conventional clinic services for outpatients. It is worth considering applying this practice widely in the medical and health services.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.
ABSTRACT
Objective To assess the cost of launching telemedicine services by Peking Union Medical College Hospital (PUMCH) during coronavirus disease 2019 pandemic. Methods The patients using telemedicine services were enrolled during the period of pilot run from February 10th to April 15th, 2020. The study was done from the social perspective. A decision-tree model was constructed to compare the costs between telemedicine services and conventional clinical services for outpatients. The main outcome was measured as incre- mental cost-effective ness ratios (ICER). Sensitivity analysis was conducted by using one-way sensitivity analysis. Results During a period of forty-seven days, the online fever clinic was applied 3055 person-times(2070 patients) and the online outpatient clinic were applied 36 549 person-times(20 467 patients). On average, 44 febrile cases/d and 435 nonfebrile cases/d were reduced in the outpatient clinic. It helped to reduce roughly 1/4 (febrile) and 1/5(nonfebrile) of total numbers of the patients in the outpatient clinic during the peak period of the epidemic. If calculated according to the actual free-of-charge condition, the ICER was -64.7 yuans/person-time. If the actual cost of each consultant of telemedicine service was estimated according to the level of outpatient-service fee, the ICER was -5.5 yuans/person-time. The results of sensitivity analysis showed that the main factors affecting the ICERs were transportation cost, lost wages, and the efficiency of telemedicine services. Conclusions Launching telemedicine services helped to relieve the pressure at the outpatient clinics, and has the potential to provide significant cost saving compared to conventional clinic services for outpatients. It is worth considering applying this practice widely in the medical and health services. © 2021, Peking Union Medical College Hospital. All rights reserved.
ABSTRACT
OBJECTIVE: COVID-19 can cause severe acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We performed a rapid systematic review focusing on the use of ECMO in patients with COVID-19. MATERIALS AND METHODS: PubMed/MEDLINE, Google Scholar, Embase, the Cochrane Library, EBSCO and Ovid (updated 30 April 2020) were systematically searched. Case reports/Case series from COVID-19 patients treated with ECMO were included in the study. Three reviewers assessed, selected, and abstracted data from studies. All disparate opinions were resolved through discussion. RESULTS: We included 13 articles for systematic evaluation, including 10 case reports and 3 case series studies, with a total of 72 patients. We search for the following information: First author of articles; Patient's location; age; gender; body mass index (BMI); Comorbidities; Time on ECMO; Mode of ECMO; treatments and clinical outcomes. As of all reporting times, our data show that 38 patients (52.8%) have died definitively, 13 patients (18.0%) were still receiving ECMO treatment, 12 patients (16.7%) were alive, 7 patients (9.7%) were recovery and 2 cases (2.8%) remained hospitalized. CONCLUSIONS: ECMO plays an important role in the stabilization and survival critically ill patients with COVID-19, but the usefulness of ECMO in reducing the mortality of severe ARDS caused by COVID-19 was limited. Therefore, a larger sample size study and a comprehensive analysis of evaluating the medical value of using ECMO on COVID-19 patients are urgently required.