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

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 health care, 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 health care 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 economic and environmental impacts of video consultations, taking into account the goal of carbon neutrality for the German health care system by 2030. Methods We conducted a prospective randomized controlled trial 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 and time costs and production losses. Examination of the environmental impact comprised the emissions of greenhouse gases, carbon monoxide, volatile hydrocarbons, nitrogen oxides, and 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 reduce travel costs, time costs, and production losses, resulting in mean cost savings of €76.52 per video consultation. In addition, emissions of 11.248 kg of greenhouse gases, 0.070 kg of carbon monoxide, 0.011 kg of volatile hydrocarbons, 0.028 kg of nitrogen oxides, and 0.0004 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 patients in orthopedic and trauma surgery 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 use of digital health during and beyond the COVID-19 pandemic, providing decision makers with data for both economic and 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. Trial Registration German Clinical Trials Register DRKS00023445; https://tinyurl.com/4pcvhz4n

Digitization of Follow-Up Care in Orthopedic and Trauma Surgery With Video Consultations: Health Economic Evaluation Study From a Health Provider’s Perspective

“…From the health provider’s perspective, these results suggest that video consultations might be suitable for use in orthopedic and trauma surgery. The potential of video consultations is further underlined by previous studies that found comparable results to F2F consultations in terms of physician and patient satisfaction, efficiency, quality of care, and benefits from a societal perspective [ 16 , 18 , 19 , 29 - 32 ].…”

“…In addition, the implementation of telemedicine could result in a competitive advantage for clinics, as communication with patients is simplified and, as a result, a service beyond the local environment could be offered [ 35 ]. As telemedicine is associated with cost and time savings for patients as well, the offering of video consultations could furthermore help to recruit new patients [ 16 , 17 , 19 , 30 ]. The implementation of video consultations could also create the possibility of a home office for physicians.…”

“…Our study design had 3 main goals: evaluation of patient and physician satisfaction, evaluation of economic and environmental impact from a societal perspective, and a health economic analysis of digitization from the hospital’s perspective. The first 2 evaluations have been previously published with a detailed description of our study design [ 18 , 19 ].…”

A Telemedicine Center Reduces the Comprehensive Carbon Footprint in Primary Care: A Monocenter, Retrospective Study

“…Overall, the studies primarily focus on the US and UK; for Europe, there are occasional reports on Spain, 18 Sweden, 19 Portugal, 20 or Germany. 21 In their study on telemedical services in Spain, Morcillo Serra et al, 22 find that the heavy use of telemedicine saved an estimated 6655 net tons of CO 2 eq in 2020. Every telemedical consultation helped save an average of 3.057 kg of net CO 2 eq, and every downloaded medical report instead of getting them to the patients via conventional ways, another 1.5 kg.…”

“…Overall, the studies primarily focus on the US and UK; for Europe, there are occasional reports on Spain, 18 Sweden, 19 Portugal, 20 or Germany. 21 …”