P3159Economic impact of avoiding unnecessary transfer & hospitalization - results from Latin AmericaTtelemedicine Infarct Network (LATIN)

Abstract

Background: Latin America Telemedicine Infarct Network (LATIN) was designed to utilize telemedicine to create a population-based, hub and spoke, AMI program in Brazil, Colombia and Mexico. We have previously reported increased access, accuracy and utilization of guidelines-based AMI management with LATIN. Purpose: Telemedicine addresses several challenges in population-based AMI management including reducing transfer, hospitalization, unnecessary procedures and patient stress. We report on the economic impact of LATIN with an estimate of the costs and benefits of telemedicine to avoid patient transfer, hospitalization and treatment. Methods: 520,882 telemedicine encounters in LATIN spokes (small clinics and primary health centers in remote areas) were evaluated. The cost benefit analysis was conducted from the hubs, spokes and telemedicine centers and it includes technology, transfer, inpatient and procedure associated savings. Sensitivity analysis was conducted by examining the worst and best scenarios of costs, revenues and savings. A comparison with a recently reported data at Avera e-Emergency program in Sioux Falls, South Dakota, involving 85 rural hospitals across 7 states is provided (13% transfer avoidance). Results: From the 520,882 screened patients, there were 6,250 with STEMI (1.2%). Of these, 2,687 (43%) were treated with urgent reperfusion, including 2,050 (76.2%) with PPCI. A total of 518,195 patient transfers were avoided and attributed to telemedicine guided accurate diagnosis and management. LATIN process costs, including those for IT infrastructure and expert guidance were $172; transfer and indirect patient costs were $628. Net savings per telemedicine encounter were $516 and the calculated overall savings, till date, for LATIN range between $79.6 million (30% transfer avoidance, best scenario) to $ 26.5million (10% transfer avoidance, worse scenario). (Table presented) Conclusions: Telemedicine is an extremely cost-effective strategy for populationbased AMI management. The large savings result from accurate and robust telemedicine diagnosis that prevents unnecessary transfer and hospitalization.