Economic Evaluation of the Pediatric Tele-resuscitation Intervention Pilot Study

Abstract

Background: Pediatric Telemedicine Connecting Hospitals (Peds–TECH), a pediatric tele-resuscitation intervention, was developed in partnership with Niagara Health, Brock University and McMaster Children's Hospital. This network aims to enhance pediatric outcomes for infants and children who present to NH hospitals' emergency departments using telemedicine (TM). Objectives: This study aimed to (i) identify out-of-pocket (OOP) costs and time/productivity losses for parents of pediatric patients seeking care at the emergency department (ED); (ii) calculate financial spending within the Peds-TECH intervention and estimate health resource utilization (HRU) costs; (iii) determine the clinical effectiveness of the Peds-TECH intervention on emergency transfers to a tertiary care hospital, and survival/mortality outcomes; and (iv) estimate an incremental cost effectiveness ratio (ICER) of Peds-TECH intervention compared to usual care (i.e., conventional means of providing resuscitation in ED). Methods: A mixed methods quasi-experimental research design was used for this project that included quantitative and qualitative methods in the economic evaluation. This study used qualitative research in the form of interviews, to explore OOP expenses incurred by parents of pediatric patients treated with the Peds-TECH intervention, and quantitative research when determining costs related to health technology and HRU. The ICER represents the incremental costs (Canadian dollar) relative to the years of life lost (YLL) averted in the intervention compared to usual care. The willingness-to-pay (WTP) threshold of $50,000 was considered to interpret the cost-effectiveness of the Peds-TECH intervention. Results: Qualitative interviews with parents revealed OOP expenses pertinent to personal transportation, food/meal, and time/productivity losses. In terms of OOP costs, the largest category in terms of both overall cost ($435) and response rate (5/5) was travel/parking costs. The next most common response to expenses incurred was the cost of food/meals ($80) with a response rate of 3/5. One participant did report paying for hotel accommodations for one day ($120). The odds ratio (OR) for mortality among cases was 0.498 (95% CI, 0.173, 1.43) compared to controls (i.e., usual care), indicating that the intervention was protective against mortality. An ICER of $64.61 per YLL averted was determined from the CEA, which represents the cost for an additional life-year saved in the intervention group compared to the control. In the deterministic sensitivity analysis, the ICER ranged as low as (- 138.72) and as high as (489.75) per YLL averted. The probabilistic analysis indicated 96.1% probability that Peds-TECH is cost-effective under a $5K WTP threshold, which is much lower than the standard $50K WTP threshold. Conclusion: This study acknowledged gaps surrounding the OOP costs associated with pediatric emergencies in the Niagara Region. The Peds-TECH intervention is considered clinically effective in preventing mortality among pediatric patients compared to usual care. As well, it was determined that the Peds-TECH intervention is highly cost-effective with an ICER of $64.61 per YLL averted. Further research is warranted to assess the long-term costs and health outcomes of pediatric patients undergoing the Peds-TECH intervention.