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

BMJ 2003; 327 doi: (Published 10 July 2003) Cite this as: BMJ 2003;327:84
  1. P B Jacklin, research fellow (health economics) (paul.jacklin{at},
  2. J A Roberts, professor of economics of public health1,
  3. P Wallace, professor of primary care3,
  4. A Haines, professor of public health and primary care2,
  5. R Harrison, senior research fellow (telemedicine)3,
  6. J A Barber, lecturer in medical statistics4,
  7. S G Thompson, professor of biostatistics5,
  8. L Lewis, project manager6,
  9. R Currell, research and development officer6,
  10. S Parker, research nurse3,
  11. P Wainwright, senior lecturer6,
  12. the Virtual Outreach Project Group
  1. 1Department of Public Health Policy, London School of Hygiene and Tropical Medicine, London WC1 7HT
  2. 2Dean's Office, London School of Hygiene and Tropical Medicine
  3. 3Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2PF
  4. 4University College Hospitals Research and Development Directorate, Hampstead Road, London NW1 2LT
  5. 5MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2 2SR
  6. 6School of Health Science, University of Wales Swansea, Swansea SA2 8PP
  1. Correspondence to: P B Jacklin
  • Accepted 21 April 2003


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.


  • Contributors P Wallace, AH, RH, JAR, and Will Clayton were involved in developing the original idea for funding and were co-applicants on the successful funding proposal. P Wallace was responsible for the overall direction of the project. RH coordinated and led the assembly and production of the proposal and collaborated with PBJ in data collection and processing. SGT and JPB provided statistical advice, and JB was responsible for data cleaning and analysis. JAR was involved in the development of the economic framework for the study, and together with PBJ provided health economics advice. PBJ undertook analysis of economic data. P Wainwright, RC, SP, LL, and PBJ contributed to the development of data collection instruments and methods of analysis. RC, SP, and Carol Jarrett, together with PBJ, planned and carried out the collection of NHS resource use data. All the authors were members of the steering group and contributed to the drafting of the paper. P Wallace is the guarantor.

  • Funding NHS research and development health technology assessment programme, with additional contributions from BT and the MSD Foundation. The views and opinions expressed are those of the authors and do not necessary reflect those of the NHS Executive.

  • Competing interests None declared. Neither BT nor the MSD Foundation had any influence over the design, execution, analysis, or interpretation of the study results.

  • Ethical approval: All the relevant local research ethics committees approved the study.

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