So here it is, the most important question – How much does it costs to set up and maintain a telemedicine network?
To get some ideas on the costs of a telemedicine network I look through published literature as well as surfed the web to find the information I needed. In the published literature, very few studies have been done to evaluate the cost-effectiveness of telemedicine. This is mainly because telemedicine is a very new field of medicine and there is no set criteria or guideliness to evaluate a telemedicine network. A systemic review paper published in the British Medical Journal (BMJ) examined 554 studies done to evaluate the cost-effectiveness of telemedicine and found only 9 of these studies gave usefull information about whether telemedicine is effective considering the costs. The authors of the study concluded that there is no good evidence to say that telemedicine is a cost-effective way to deliver health care. That particular study was done in 2002.
Closer to home, in Solomon Islands, their experiences has been that the time it takes to get the results of a pathology specimen (perviously sent to Australia) has been reduced from months to just hours thanks to their telemedicine network. In my experiences at the Port Moresby General Hospital, the pathology specimens for outer hospitals like Goroka, Mt. Hagen or Nonga, the results takes months, even years! This is simply because we just don’t have enough pathologists. There are in fact only 5 pathologists (last count) for a country of nearly 6 million!!
As a result the result probably goes out after the patient has been discharged and gone home or died in some unfornate cases. Is the high costs (in my opion) of a telemedicine network in a developing country justified for a speedy result? And will that result influence in a positive way the outcome of the patient?
I have joined a telemedicine Internet discussion group called “Telemedicine in low resource settings” and asked some of the members on the costs of telemedicine in a developing country and waiting for their reply. Many of the members are from African countries and I am sure they will help me with some my queries.
In the meantime, I got some information regarding the costs of a telemedicine as used in USA. So will give some figures so that we can have some idea.
The National Institute of Justice when evaluating their telemedicine services to in-mates estimated that it costs almost US$ 778,000 to provide 1,321 consulations at an average of US$589 per encounter. Compare that to conventional consultations which was estimated at US$108 per consultation. Now this is the full range of telemedicine services including video conferences. Read here the full report. My feeling is that if telemedicine services are tailored to a particular need, e.g in my case ONLY telepathology services, I think the cost would be considirably less.
According to Telemedicine Today, a typical interactive equipment costs from US$3000-8000 per nursing station and US$4500 per patient unit. The transimission charges run at least at US$20/hour depending on the communication speed and methodology. Again, these quoted figures included the full range of telemedicine set up.
In a telemedicine pilot project in Peru, 39 establishements were assessed for their cost-effectiveness. The estimated costs came to US$4195 per establishment and the systems maintaince and repair at US$704/month. They estimated that the total costs of the system would be recovered from savings generated in 2.5 years time. Read the full report here.
This is just to get a glimps of the estimated costs of a telmedicine network. In developing countries medical informatics is still early and most countries do not have access to the technologies that make telemedicine or telepathology work. However, I think for a country like PNG we have to focus on sharing information to make better decisions. If and when we have a telmedicine network, we have to make sure the system is set up to fascilitate and speed up communication betweek rural health centres, provincial hospitals and base hospitals.