Patients with cancer often experience significant financial toxicity due to the high direct and indirect costs associated with their care. These costs include the treatments themselves, as well as a decline in productivity and expenses related to commuting to and from appointments. During the COVID-19 pandemic, telemedicine use grew exponentially, as it allowed many aspects of oncology care to continue while limiting patients’ and healthcare workers’ exposure to the coronavirus.
Results from a recent study by Krupal B. Patel, MD, MSc, FRCSC, Surgeon, Department of Head and Neck–Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, and colleagues, published in JAMA Network Open, indicate that the adoption of telehealth services during the pandemic saved patients with cancer both time and travel costs, reducing the cost burden associated with their care.1
Between April 1, 2020, and June 30, 2021, data were collected from completed telemedicine visits at Moffitt Cancer Center. The researchers included 25,496 telehealth visits with 11,688 patients aged 18 to 65 years during the study period.
There were 4525 (3795 patients) new or established visits and 20,971 (10,049 patients) follow-up visits. The median age of patients was 55 years, with 15,663 (61.4%) visits by women, 18,443 (72.3%) visits by patients with private insurance, and 18,360 (72.0%) visits by White non-Hispanic individuals.
The researchers divided visits into 3 categories: (1) new visits for patients who had not received previous care at the center; (2) established visits for patients who had received previous care at the center but were referred to a new subspecialty for consultation; and (3) follow-up visits for patients who had visits for care in the same subspecialty they had received previous care at the cancer center.
Time savings were calculated as the difference between the roundtrip time required to travel from the patient’s home address to an in-person consultation at the center, plus in-person consultation time versus the time required to attend a telehealth visit from home.
An estimated 3,789,963 roundtrip miles (804,969 for new or established visits and 2,984,994 for follow-up visits) were saved, equating to 75,055 hours (15,422 for new or established visits and 59,633 for follow-up visits) of savings in total driving time. Per visit, the use of telehealth was associated with a mean savings of 148.6 (standard deviation [SD], 143.7) roundtrip travel miles and 2.9 (SD, 2.3) hours of roundtrip driving time.
Furthermore, 29,626 hours of in-clinic visits were saved by using telehealth with a mean savings of 1.2 (SD, 0.13) hours per visit. For new or established visits, telehealth was associated with mean savings of 177.6 (SD, 161.6) roundtrip travel miles, 3.4 (SD, 2.6) hours of roundtrip driving time, and 1.5 (SD, 0.0) hours of in-clinic time per visit. For follow-up visits, telehealth was associated with mean savings of 142.4 (SD, 138.8) roundtrip travel miles, 2.8 (SD, 2.3) hours of roundtrip driving time, and 1.1 (SD, 0.0) hours of in-clinic time per visit.
The researchers used the American Community Survey to identify census tract-level data for hourly median income per year. This study focused on patients aged <65 years because they were more likely to be employed full time compared with patients aged ≥65 years.
Telehealth was associated with an estimated $1,637,407 total savings in lost productivity ($349,655 for new or established visits and $1,287,752 for follow-up visits). In total, for new or established visits, the mean cost savings per visit ranged from $176.6 (SD, $136.3) at $0.56/mile to $222.8 (SD, $177.4) at $0.82/mile, and for follow-up visits, the mean total cost savings per visit was $141.1 (SD, $115.3) at $0.56/mile to $178.1 (SD, $150.9) at $0.82/mile.
“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,” Dr Patel and colleagues noted.
The researchers admitted that the study did have limitations, since it focused on patients attending a tertiary/quaternary referral center, where patients may have had to travel a longer distance due to their specific need for cancer care. Income estimates and employment rates could also vary because of some patients’ inability to work during treatment, thus varying the estimated savings from loss of productivity. In addition, it was assumed that travel time and hours of visit time could not be made up for when evaluating cost savings due to loss of productivity.
The study also did not account for the costs of the electronic devices used for the telehealth visits or the expenses associated with Internet access. Furthermore, area of residence (rural vs urban), race, education, and insurance type were not considered, which the researchers said should be explored in future studies.
“Patients with cancer spend a substantial amount of time and money traveling to receive care. Using a large data set, we found that cancer care delivery via telehealth was associated with time, travel, and cost savings for patients with cancer, which may reduce the financial toxicity of cancer care. Future studies should explore other cost savings, such as the savings to cancer caregivers and how these vary for rural and urban patients with cancer,” Dr Patel and colleagues concluded.
- Patel K, Turner K, Alishahi Tabriz A, et al. Estimated indirect cost savings of using telehealth among nonelderly patients with cancer. JAMA Netw Open. 2023;6:e2250211.