Increasing the number of telehealth visits for cancer patients could reduce the financial toxicity of oncology services.
Telehealth visits generate significant cost savings for adult cancer patients younger than 65, according to a new research article.
Cancer is among the most expensive medical conditions to treat in the United States, according to the National Cancer Institute (NCI). Direct costs include multiple types of treatments such as surgery, chemotherapy, and radiation therapy. Indirect costs include travel expenses and lost employment productivity for clinical visits.
The new research article, which was published by JAMA Network Open, examines indirect cost savings for more than 11,000 patients with more than 25,000 telehealth visits at Moffitt Cancer Center, the only NCI-designated Comprehensive Cancer Center in Florida. The telehealth visits were conducted from April 1, 2020, to June 30, 2021.
The study accounts for two indirect costs: roundtrip car travel and loss of productivity because of travel and the additional time associated with in-person visits compared to telehealth visits. The researchers divided visits in three categories: new visits for patients who had not received previous care at the cancer center, established visits for patients who had received previous care at the cancer center but were referred to a new subspecialty for consultation, and follow-up visits for patients who had visits for care in the same subspecialty they had received previous care at the cancer center.
The study has several key data points:
- Based on two cost models for telehealth visits, the mean total saving in indirect costs ranged from $147.4 to $186.1 per visit
- For new and established telehealth visits, the mean total cost savings per visit ranged from $176.6 at $0.56 per mile of travel to $222.8 at $0.82 per mile of travel
- For follow-up telehealth visits, the mean total cost savings per visit was $141.1 at $0.56 per mile of travel to $178.1 at $0.82 per mile of travel
- About 3,790,000 roundtrip miles were avoided, which generated more than 75,000 hours of savings in total driving time
- Telehealth visits generated about $1,170,000 savings in lost income because of driving time and about $467,000 savings in lost productivity because of visit time
- The mean driving cost savings per telehealth visit ranged from $83.2 at $0.56 per mile of travel to $122.0 at $0.82 per mile of travel
"These findings suggest that telehealth saves time, travel, and money for patients, which could improve care delivery and may reduce the financial toxicity of cancer care," the study's co-authors wrote.
Interpreting the data
The indirect cost savings from cancer telehealth visits are substantial, the study's co-authors wrote. "Telehealth was associated with a total savings of 3,789,963 roundtrip travel miles, which equates to traveling 152.2 times around the earth, and a total savings of 75,055 roundtrip drive hours, which equates to 8.6 calendar years. An additional 3.4 calendar years (29,626 hours) were saved in clinic visits by using telehealth."
Travel is a significant factor in cancer care, the co-authors wrote. "The burden of travel has been identified as an important factor that can change access to diagnosis, treatment of cancer and participation in clinical trials. Transportation is a key determinant of healthcare access and has been identified as an important source of out-of-pocket nonmedical costs for patients receiving cancer care. Patients without adequate transportation are more likely to miss appointments and rely on emergency department care, and there is substantial variability in the estimated parking costs throughout cancer treatment."
Rural cancer patients could benefit most from telehealth, the co-authors wrote. "A recent study noted that the number of rural hospitals has decreased over the last decade, resulting in almost double the number of people living outside a 60-minute radius of major hospitals and longer drive times to receive care. Thus, telehealth could be beneficial among rural patients in particular."
The study underestimates the indirect cost savings generated by telehealth cancer care, the co-authors wrote. "We did not consider the cost savings of telehealth for cancer caregivers. Caregivers for patients with cancer spend substantial time and effort to coordinate and attend appointments with patients. … Therefore, savings from telehealth would be even higher if caregivers' savings from lost productivity were accounted for, especially when telehealth has the ability for multiple caregivers to join the same appointment from various geographical locations."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Based on two cost models for telehealth visits, the mean total saving in indirect costs ranged from $147.4 to $186.1 per visit.
For more than 11,000 cancer patients in the study, about 3,790,000 roundtrip miles were avoided, which generated more than 75,000 hours of savings in total driving time.
The mean driving cost savings per telehealth visit ranged from $83.2 at $0.56 per mile of travel to $122.0 at $0.82 per mile of travel.