24 - Modeling the Cost of Teleneonatology from the Health System Perspective

Poster Number: 24
Publication Number: 24.338

Jennifer Fang, Mayo Clinic Children's Center, Rochester, MN, United States; Viengneesee Thao, Mayo Clinic, Rochester, MN, United States; Ruchita Dholakia, Mayo Clinic, Rochester, MN, United States; Beth L. Kreofsky, Mayo Clinic, Rochester, MN, United States; James Moriarty, Mayo Clinic, Rochester, MN, United States; Christopher Colby, Mayo Clinic Children's Center, Rochester, MN, United States; Bart M. Demaerschalk, Mayo Clinic College of Medicine and Science, Phoenix, AZ, United States; Bijan Borah, Mayo Clinic Alix School of Medicine, Rochester, MN, United States

Background: Teleneonatology (TN) allows remote neonatologists to provide real-time audio-video telemedicine support to community hospitals when neonates require advanced resuscitation or critical care. Economic evaluation of this innovative care model is critical for establishing value, ensuring payment, and maintaining program funding. While there is evidence of the positive impact of teleneonatology on patient care, there are no published economic evaluations of U.S. teleneonatology programs.

Objective: To evaluate the cost of teleneonatology from the perspective of the health care system.

Design/Methods: We constructed a decision tree comparing TN to usual care for neonates born in hospitals without a NICU who require consultation. A diagram of the decision tree is shown in Figure 1. Our outcome of interest was total cost per patient, which included the incremental cost of a TN program, the cost of medical transport, and the cost of NICU or non-NICU hospitalization. The costs of care for each cohort were determined using published literature and informed by any between group differences in rate of transfer to a higher level of care and cost of hospitalization. Parameters used in the base-case model are summarized in Table 1. We performed threshold sensitivity analyses where we varied each parameter to determine whether the base-case finding reverted.

Results: For neonates requiring consultation after birth in a hospital without a NICU, TN was less costly ($16,878) than usual care ($28,047), representing a cost-savings of $11,168 per patient. Sensitivity analyses, shown in Figure 2, demonstrated that at least one of the following conditions would need to be met for TN to no longer be cost saving compared to usual care: transfer rate with usual care < 12% (base-case=82%), TN reducing the odds of transfer by < 8% (base-case=52%), or TN cost exceeding $12,989 per patient (base-case=$1,821 per patient).Conclusion(s): Economic modeling from the health system perspective demonstrated that teleneonatology was cost saving compared to usual care for neonates requiring consultation following delivery in a non-NICU hospital. Understanding the cost savings associated with teleneonatology may influence organizational decisions regarding implementation, diffusion, and retention of these programs.
Figure 1Cost decision tree for teleneonatology.
Table 1Model parameters