BMJ  2003;327:84 (12 July), doi:10.1136/bmj.327.7406.84

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Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion

¹ Department of Public Health Policy, London School of Hygiene and Tropical Medicine, London WC1 7HT, ² Dean's Office, London School of Hygiene and Tropical Medicine, ³ Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2PF, ⁴ University College Hospitals Research and Development Directorate, Hampstead Road, London NW1 2LT, ⁵ MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2 2SR, ⁶ School of Health Science, University of Wales Swansea, Swansea SA2 8PP

Objectives To test the hypotheses that, compared with conventional outpatient consultations, joint teleconsultation (virtual outreach) would incur no increased costs to the NHS, reduce costs to patients, and reduce absences from work by patients and their carers.

Design Cost consequences study alongside randomised controlled trial.

Setting Two hospitals in London and Shrewsbury and 29 general practices in inner London and Wales.

Participants 3170 patients identified; 2094 eligible for inclusion and willing to participate. 1051 randomised to virtual outreach and 1043 to standard outpatient appointments.

Main outcome measures NHS costs, patient costs, health status (SF-12), time spent attending index consultation, patient satisfaction.

Results Overall six months costs were greater for the virtual outreach consultations (£724 per patient) than for conventional outpatient appointments (£625): difference in means £99 ($162; €138) (95% confidence interval £10 to £187, P=0.03). If the analysis is restricted to resource items deemed "attributable" to the index consultation, six month costs were still greater for virtual outreach: difference in means £108 (£73 to £142, P < 0.0001). In both analyses the index consultation accounted for the excess cost. Savings to patients in terms of costs and time occurred in both centres: difference in mean total patient cost £8 (£5 to £10, P < 0.0001). Loss of productive time was less in the virtual outreach group: difference in mean cost £11 (£10 to £12, P < 0.0001).

Conclusion The main hypothesis that virtual outreach would be cost neutral is rejected, but the hypotheses that costs to patients and losses in productivity would be lower are supported.

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