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Cost Analysis of Launching Telemedicine Services by Peking Union MedicalCollege Hospital During the Pandemic of Coronavirus Disease 2019
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摘要:
目的 初步评估北京协和医院在新型冠状病毒肺炎疫情防控期间提供互联网线上诊疗服务的成本效果。 方法 回顾性收集并分析2020年2月10日至4月15日北京协和医院互联网线上诊疗服务试运行期间，所有接受线上门诊问诊的患者临床资料。选取社会立场角度，采用决策树法比较互联网线上诊疗的成本效果，结果以增量成本效果比表示。采用单因素分析法分析模型的敏感性。 结果 互联网线上诊疗系统试运行47 d内，线上接诊发热问诊3055人次、2070例患者，平均可减少线下发热门诊就诊约44例/d，约为疫情高峰期发热门诊日均实际接诊量的1/4;接诊非发热相关问诊36 549人次、20 467例患者，平均可减少线下非发热门诊就诊约435例/d，约为疫情高峰期门诊日均总量的1/5。以实际线上诊疗免问诊费计算，增量成本效果比为-64.7元/人次问诊。如按门诊医事服务费水平估算每例问诊的实际成本，则最终增量成本效果比为-5.5元/人次问诊。敏感性分析结果表明，患者往来交通费用、误工费以及互联网线上诊疗解决问题有效率是影响增量成本效果的主要因素。 结论 新型冠状病毒肺炎疫情期间，北京协和医院提供的互联网线上诊疗服务不仅有效配合了政府防疫政策执行，同时可节约患者的经济成本，为优化医疗卫生服务提供了解决思路。 Abstract:Objective To assess the cost of launching telemedicine services by Peking Union Medical College Hospital (PUMCH) during coronavirus disease 2019 pandemic. Methods The patients using telemedicine services were enrolled during the period of pilot run from February 10th to April 15th, 2020. The study was done from the social perspective. A decision-tree model was constructed to compare the costs between telemedicine services and conventional clinical services for outpatients. The main outcome was measured as incre- mental cost-effective ness ratios (ICER). Sensitivity analysis was conducted by using one-way sensitivity analysis. Results During a period of forty-seven days, the online fever clinic was applied 3055 person-times(2070 patients) and the online outpatient clinic were applied 36 549 person-times(20 467 patients). On average, 44 febrile cases/d and 435 nonfebrile cases/d were reduced in the outpatient clinic. It helped to reduce roughly 1/4 (febrile) and 1/5(nonfebrile) of total numbers of the patients in the outpatient clinic during the peak period of the epidemic. If calculated according to the actual free-of-charge condition, the ICER was -64.7 yuans/person-time. If the actual cost of each consultant of telemedicine service was estimated according to the level of outpatient-service fee, the ICER was -5.5 yuans/person-time. The results of sensitivity analysis showed that the main factors affecting the ICERs were transportation cost, lost wages, and the efficiency of telemedicine services. Conclusions Launching telemedicine services helped to relieve the pressure at the outpatient clinics, and has the potential to provide significant cost saving compared to conventional clinic services for outpatients. It is worth considering applying this practice widely in the medical and health services. -
Key words:
- coronavirus disease 2019 /
- telemedicine /
- cost analysis
作者贡献：焦洋、朱卫国提出研究设计思路; 焦洋、秦明伟、胡冰冰、潘慧、孙国强、陈思、朱卫国共同进行数据整理和分析; 焦洋完成文章初稿; 所有作者均参与文章修改。利益冲突 无 -
表 1 决策树模型参数的基准值和参考来源
指标 基准值 变化范围 参考来源 成本 App开发及硬件设施购置 125.5万元 ±20% 信息专家意见 年运维费用 79万元 非发热线上问诊费用 60元 50~100 北京地区副主任医师门诊医事服务费 发热线上问诊费用 50元 40~60 北京地区主治医师门诊医事服务费 收益 误工费 24/h ±50% 以北京每日最低时薪为基准 市内交通费 30元 ±20% 以北京10公里出租车费用为基准 省际交通费 视具体省会而不同 ±50% 以工作日省会城市至北京的火车或飞机最低往来价格为基准 远程问诊有效率 可解决问题就诊人次/线上就诊人次 70% 50%~90% 临床专家意见 
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