What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation

OBJECTIVE: This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. DESIGN: Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. SETTING: Champlain health region in Eastern Ontario, Canada. POPULATION: Primary care providers and specialists registered to use the eConsult service. MAIN OUTCOME MEASURES: Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. RESULTS: A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. CONCLUSIONS: Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner.