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
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.