Journal of Telemedicine and Telecare > Volume 14, Number 8 > Pp. 421-426

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RESEARCH Original articles

Cost implications of introducing a telecardiology service to support fetal ultrasound screening

Robin Dowie ^* , Hema Mistry ^*, Tracey A Young , Rodney CG Franklin  and Helena M Gardiner  

^* Health Economics Research Group, Brunel University, Uxbridge; Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield; Brompton Fetal Cardiology, Royal Brompton and Harefield NHS Trust, London; Institute of Reproductive and Developmental Biology, Imperial College, London, UK

Correspondence: Robin Dowie, Health Economics Research Group, Brunel University, Uxbridge UB8 3PH, UK (Fax: +44 1895 269 708; Email: robin.dowie{at}brunel.ac.uk)

A district hospital in south-east England used a telecardiology service for fetal cardiac diagnosis alongside an existing arrangement for referring pregnant women directly to perinatal cardiologists in London for detailed fetal echocardiography. Women were identified for referral according to local protocols when having a second trimester anomaly scan. For the telemedicine referrals, the sonographers video-recorded images from the anomaly scans for transmission during monthly videoconferences. The cost of the women's antenatal care was calculated from the specialist assessment until delivery, while family costs were collected in a postal survey. Over 15 months, telemedicine was used in 52 cases, while 24 women were seen in London. The London women were more likely to have had an ultrasound abnormality (29% v 10%, P = 0.047). A telemedicine assessment of 5 min duration was more costly than an examination in London (mean cost per referral of £206 v £74, P < 0.001). However, the telecardiology service was cost neutral after 14 days and for the extended period until delivery. Travel costs for London women averaged £37 compared with £5.50 for the telemedicine referrals. Telemedicine may be useful to support perinatal cardiologists in the UK whose workloads are expanding in response to improved standards in antenatal ultrasound screening.

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