Timely detection of congenital anomalies using ultrasound improves neonatal care. As specialist sonographers are often geographically dispersed, they are sometimes requested to provide a second opinion via tele-expertise. The present study aimed to evaluate the economic impact of asynchronous tele-expertise in obstetric ultrasound care in private medical practice through a comparison with face-to-face consultations. We conducted a cost minimization analysis using decision tree modeling in order to determine whether asynchronous tele-expertise or face-to-face consultation had the lowest cost, under the assumption of equivalent effectiveness in terms of prenatal diagnosis. Costs were measured from the societal perspective. The data for the base case of our modeling came from a retrospective analysis of the clinical practice of an expert who had been conducting asynchronous tele-expertise for 4 years in France. The study included 260 patients for whom 322 requests for expert opinions were made by physicians/midwives from January 2016 to January 2020. The expected average total cost for tele-expertise for a patient was €74.45 (95% CI: €66.36–€82.54) compared to €195.02 (95% CI: €183.90–€206.14) for the conventional face-to-face strategy. Accordingly, using tele-expertise led to a statistically significant reduction of €120.57 in the average total cost per patient. A sensitivity analysis confirmed the robustness of the model produced. The results of the present study underline the efficiency of tele-expertise and highlight related economic benefits. Accordingly, they could inform public health policy on the dissemination of tele-expertise in the field of obstetric ultrasound care.
DrummondMF. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press, 1997, (Oxford medical publications).
2.
DecalfDY. Concertation sur le projet de Loi de Santé: Rapport de la mission sur la médecine spécialisée libérale. République Française: Ministère de la santé et de la prévention, 18 Mars2015.
3.
AbramowiczJS. Obstetric ultrasound: where are we and where are we going?Ultrasonography2021; 40: 57–74.
4.
GeoffroyOAcarPCailletD, et al.Videoconference pediatric and congenital cardiology consultations: a new application in telemedicine. Arch Cardiovasc Dis2008; 101: 89–93.
5.
AdambounouKFarinFBoucherA, et al.Système de télé-expertise échographique temps réel et de télédiagnostic échographique temps différé. Étude pilote au Togo. Médecine et Santé Tropicales2012; 22: 54–60.
6.
FerlinRMVaz-OlianiDMFerreiraAC,et al.Tele-obstetric ultrasound: analysis of first-trimester ultrasound images transmitted in realtime. J Telemed Telecare2012; 18: 54–58.
7.
MaloneFDNoresJAAthanassiouA, et al.Validation of fetal telemedicine as a new obstetric imaging technique. Am J Obst Gynecol1997; 177: 626–631.
8.
NoresJMaloneFAthanassiouA,et al.Validation of first-trimester telemedicine as an obstetric imaging technology: a feasibility study. Obstet Gynecol1997; 90: 353–356.
9.
ViñalsFMandujanoLVargasG,et al.Prenatal diagnosis of congenital heart disease using four-dimensional spatio-temporal image correlation (STIC) telemedicine via an internet link: a pilot study. Ultrasound Obstet Gynecol2005; 25: 25–31.
10.
VinayakSSandeJNisenbaumH,et al.Training midwives to perform basic obstetric point-of-care ultrasound in rural areas using a tablet platform and mobile phone transmission technology—a WFUMB COE project. Ultrasound Med Biol1 oct 2017; 43: 2125–2132.
11.
AllelyEB. Synchronous and asynchronous telemedicine. J Med Syst1995; 19: 207–212.
12.
Thai-DucATCourouge-DorcierD. Choix entre télé-expertise et téléconsultation. Eur Res Telemed2017; 6: 43–44.
13.
BrittonNMillerMASafadiS,et al.Tele-ultrasound in resource-limited settings: a systematic review. Front Public Health2019; 7: 244.
14.
MistryHGardinerHM. The cost-effectiveness of prenatal detection for congenital heart disease using telemedicine screening. J Telemed Telecare2013; 19: 190–196.
15.
NorumJBergmoTSHoldøB, et al.A tele-obstetric broadband service including ultrasound, videoconferencing and cardiotocogram. A high cost and a low volume of patients. J Telemed Telecare2007; 13: 180–184.
16.
FiskNMSepulvedaWDrysdaleK, et al.Fetal telemedicine: six month pilot of real-time ultrasound and video consultation between the Isle of Wight and London. Br J Obstet Gynaecol1996; 103: 1092–1095.
17.
MaloneFDAthanassiouACraigoSD,et al.Cost issues surrounding the use of computerized telemedicine for obstetric ultrasonography. Ultrasound Obstet Gynecol1998; 12: 120–124.
18.
LandwehrJBZadorIEWolfeHM,et al.Telemedicine and fetal ultrasonography: assessment of technical performance and clinical feasibility. Am J Obstet Gynecol1997; 177: 846–848.
19.
McCrossanBASandsAJKileenT,et al.Fetal diagnosis of congenital heart disease by telemedicine. Archives of Disease in Childhood - Fetal and Neonatal Edition2011; 96: F394–F397.
20.
GalvánPVelazquezMBenitezG,et al.Costo-Beneficio de un Sistema de Telediagnóstico para Hospitales Regionales y Distritales del Paraguay. Rev Salud Pública Parag2015; 5: 30–39.
21.
ChanFYSoongBWatsonD,et al.Realtime fetal ultrasound by telemedicine in Queensland. A successful venture?J Telemed Telecare2001; 7: 7–11.
22.
DowieRMistryHYoungTA, et al.Telemedicine in pediatric and perinatal cardiology: economic evaluation of a service in English hospitals. Int J Technol Assess Health Care2007; 23: 116–125.
23.
SmithVJMarshallALieMLS, et al.Implementation of a fetal ultrasound telemedicine service: women’s views and family costs. BMC Pregnancy Childbirth.2021; 21: 38.
24.
LiddyCMorozIMihanA,et al.A systematic review of asynchronous, provider-to-provider, electronic consultation services to improve access to specialty care available worldwide. Telemed e-Health2019; 25: 184–198.
25.
HusereauDDrummondMPetrouS, et al.Consolidated health economic evaluation reporting standards (CHEERS)—explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health2013; 16: 231–250.
Bongiovanni-DelarozièreILe Goff-PronostM. Economic evaluation methods applied to telemedicine: from a literature review to a standardized framework. Eur Res Telemed2017; 6: 117–135.
28.
BeldjerdMLafougeASorianoAGLC,et al.La Télé-Expertise asynchrone (TEAS) en échographie obstétricale : est-ce équivalent à la consultation en présentiel?Gynécologie Obstétrique Fertilité & Sénologie2021; 49. DOI: 10.1016/j.gofs.2021.06.005.
29.
HAS. Choix méthodologiques pour l’évaluation économique à la HAS. 2020;118.
Arrêté du 22 septembre 2021 portant approbation de l’avenant n° 9 à la convention nationale organisant les rapports entre les médecins libéraux et l’assurance maladie signée le 25 août 2016. Ministère de la santé et de la prévention.
AubelN. Le voyage pendant la grossesse: Place des professionnels de santé en soins primaires pour le conseil aux femmes enceintes. Rev Prat2009; 59: 23–28.
34.
BrouwerWBFKoopmanschapMA. The friction-cost method. Pharmacoeconomics2005; 23: 105–111.
35.
BeldjerdMLafougeAGiorgiR,et al.Asynchronous tele-expertise (ASTE) for prenatal diagnosis is feasible and cost saving: results of a French case study. Plos One2022; 17: e0269477.
36.
PasquierJCMorelleMBagouetS, et al.Effects of residential distance to hospitals with neonatal surgery care on prenatal management and outcome of pregnancies with severe fetal malformations. Ultrasound Obstet Gynecol2007; 29: 271–275.
37.
AndersonGDNelson-BeckerCHanniganEV,et al.A patient-centered health care delivery system by a university obstetrics and gynecology department. Obstet Gynecol2005; 105: 205–210.
RabieNZSandlinATOunpraseuthS, et al.Teleultrasound for pre-natal diagnosis: a validation study. Australasian Journal of Ultrasound in Medicine2019; 22: 248–252.
40.
OhannessianRYaghobianSDuongTA,et al.France is the first country to reimburse tele-expertise at a national level to all medical doctors. Telemed J E Health2021; 27: 378–381.
Arrêté du 22 septembre 2021 portant approbation de l’avenant n° 9 à la convention nationale organisant les rapports entre les médecins libéraux et l’assurance maladie signée le 25 août 2016. Journal Officiel de la République Française n° 0224 du 25 septembre 2021.
