Paediatric palliative care by video consultation at home: a cost minimisation analysis

Bradford, Natalie K., Armfield, Nigel R., Young, Jeanine and Smith, Anthony C. (2014) Paediatric palliative care by video consultation at home: a cost minimisation analysis. BMC Health Services Research, 14 1: 328.1-328.18. doi:10.1186/1472-6963-14-328

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Author Bradford, Natalie K.
Armfield, Nigel R.
Young, Jeanine
Smith, Anthony C.
Title Paediatric palliative care by video consultation at home: a cost minimisation analysis
Journal name BMC Health Services Research   Check publisher's open access policy
ISSN 1472-6963
Publication date 2014-07
Sub-type Article (original research)
DOI 10.1186/1472-6963-14-328
Open Access Status DOI
Volume 14
Issue 1
Start page 328.1
End page 328.18
Total pages 18
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2015
Language eng
Formatted abstract
Background: In the vast state of Queensland, Australia, access to specialist paediatric services are only available in the capital city of Brisbane, and are limited in regional and remote locations. During home-based palliative care, it is not always desirable or practical to move a patient to attend appointments, and so access to care may be even further limited. To address these problems, at the Royal Children's Hospital (RCH) in Brisbane, a Home Telehealth Program (HTP) has been successfully established to provide palliative care consultations to families throughout Queensland.

A cost minimisation analysis was undertaken to compare the actual costs of the HTP consultations, with the estimated potential costs associated with face-to face-consultations occurring by either i) hospital based consultations in the outpatients department at the RCH, or ii) home visits from the Paediatric Palliative Care Service. The analysis was undertaken from the perspective of the Children's Health Service. The analysis was based on data from 95 home video consultations which occurred over a two year period, and included costs associated with projected: clinician time and travel; costs reimbursed to families for travel through the Patients Travel Subsidy (PTS) scheme; hospital outpatient clinic costs, project co-ordination and equipment and infrastructure costs. The mean costs per consultation were calculated for each approach.

Results: Air travel (n = 24) significantly affected the results. The mean cost of the HTP intervention was $294 and required no travel. The estimated mean cost per consultation in the hospital outpatient department was $748. The mean cost of home visits per consultation was $1214. Video consultation in the home is the most economical method of providing a consultation. The largest costs avoided to the health service are those associated with clinician time required for travel and the PTS scheme.

Conclusion: While face-to-face consultations are the gold standard of care, for families located at a distance from the hospital, video consultation in the home presents an effective and cost efficient method to deliver a consultation. Additionally video consultation in the home ensures equity of access to services and minimum disruption to hospital based palliative care teams.
Keyword Economic evaluation
Palliative care
Home telehealth
Health services research
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

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Created: Tue, 29 Jul 2014, 11:11:00 EST by Burke, Eliza on behalf of Centre for On-Line Health