ABSTRACT
During the coronavirus pandemic, asynchronous teledermatology and tele-triage have become increasingly essential, but reimbursement is not widespread. Our study of an asynchronous teledermatology eConsult program for “suspicious lesions” aims to calculate potential cost-savings of the program with recent telemedicine reimbursement rates published by the Centers for Medicare & Medicaid Services (CMS), as compared with a traditional ambulatory model, using observed and projected frequencies of skin biopsies at our institution. We conducted a 3-year retrospective cohort study of patient characteristics, clinical outcomes, and payer costs associated with “suspicious lesion” eConsults. For 348 cases receiving eConsult for a single suspicious lesion within our study period, the eConsult program cost $32,298.40 ($92.81/case). Compared with a traditional standalone ambulatory model, tele-triage could potentially save $8252.59 ($23.71/case) based on the 41.8% observed biopsy rate in eConsult patients subsequently presenting to ambulatory clinic. We calculated a minimum savings of $2348.86 ($6.75/case) using a 23.6% theoretical biopsy rate based on suspicious lesion eConsults not recommended in-person evaluation but who nonetheless presented in ambulatory clinic for assessment of the lesion. Threshold analysis using the actual cost of the eConsult program revealed that institutions with biopsy rate greater than 16.4% for new patients presenting with “suspicious lesions” could yield cost-savings from tele-triage compared with a standalone ambulatory model. Overall, health systems may consider exploring tele-triage of new patients with suspicious lesions given its potential for cost savings. Limitations of this study include its single-center, retrospective design as well as utilization of reimbursement codes from one payer type.
ABSTRACT
INTRODUCTION AND OBJECTIVE: Clinical research study can be expensive and time consuming due to high cost and/or long duration of a study. We hypothesized that research studies using online recruitment and engaging patients via social medial channels have the potential to reach a large population in a small timeframe, at a reasonable cost. This is an especially appropriate adaptation during COVID-19, with limited hospital and clinic access. To our knowledge, no prior study has performed a detailed cost analysis of the use of online recruitment of clinical sample collection. We sought to address this knowledge gap by comparing cost and efficiency of the recruitment of urine samples online compared to recruitment of urine samples at clinical research sites. METHODS: We performed a retrospective cost analysis of a cohort study comparing cost per sample and time per sample for both online and clinically recruited participants. The retrospective review was conducted from August 2020 to September 2021. During this time, cost data was collected based on patient surveys, urine sample analyses, invoices, and budget spreadsheets. The data was subsequently subjected to statistical analysis. This study was performed with full institutional IRB approval. RESULTS: Each sample collection kit contained 3 urine cups, 1 for the IC sample and 2 for control samples. Out of the 3576 (1192 IC + 2384 control) total sample cups mailed, 1,211 (677 control) samples were returned, with a return rate of 44.8% for IC samples and 28.4% for controls. Comparatively, the two clinical sites collected 305 samples in the same period. Men and women of all age groups (18+) and ethnicities enrolled in the study, representing all 50 states. Although the initial startup cost of online recruitment was higher, cost per sample for online recruited was found to be $147.06 compared to $398.14 for clinic sample. CONCLUSIONS: We conducted a nationwide, contactless, urine sample drive through online participant recruitment, in the midst of the COVID-19 pandemic. Results were compared with the samples collected in traditional clinical setting. Online patient recruitment can be utilized to collect urine sample rapidly, efficiently and at a cost per sample that was 37% of in an in-person clinic and without risk of COVID-19 exposure.
ABSTRACT
Introduction: This study evaluated the usefulness and cost-effectiveness of procalcitonin (PCT) following its introduction to aid antibiotics discontinuation in critical care patients admitted to ESHT during the COVID-19 pandemic. Methods: Non-surgical critical care patients with a diagnosis of sepsis or lower respiratory tract infection during their admission between 01st January and 30th June 2020. Retrospective analysis of data using ICCA (IntelliSpace Critical Care and Anaesthesia) to compare the number of antibiotic doses administered per patient before and after introduction of PCT. After PCT introduction, we recorded the number of PCT levels requested, their frequency as well as the level of PCT and when discontinuation occurred. Results: A total of 81 patients were included-13 admitted before PCT introduction and 68 after (this important increase in the number of patients is explained by the increased proportion of patients with COVID-19 pneumonitis). The average dose of antibiotics administered per patient was reduced by 28.8% (70.24 vs 49.98) following introduction of PCT. Despite an incurred cost of £12 per PCT assay, the overall average cost per patient was reduced by £59.60 (£257.94 vs £146.78). A lack of consistency in the frequency of PCT level request was observed. Conclusions: Introduction of PCT to aid discontinuation of antibiotics resulted in a 28.8% reduction in average antibiotics prescription and an overall cost reduction of £59.60 per patient. The reduction in antibacterial exposure also brings non-financial benefits such as increased patient safety through experience of less side-effects, reduction in antibiotics resistance among others. The lack of consistency in the requests of PCT resulted in the design of a protocol for its use within ESHT.