The Impact of Telemedicine on Indirect Patient Costs in an Outpatient Radiation Oncology Department

PURPOSE/OBJECTIVE(S): Patients incur more than medical-related expenses when attending necessary consultation and follow-up visits, including time and travel costs. With the rapid integration of telemedicine in response to the COVID-19 pandemic, our department gained another tool that has the potential to reduce the financial burden of cancer care for our patients. The aim of this study was to estimate the indirect cost savings (time, travel costs, opportunity costs) resulting from the use of telemedicine at a large, academic radiation oncology outpatient clinic located in a densely populated suburban setting. We hypothesize that telemedicine provides time- and cost-savings for patients. MATERIALS/METHODS: All telemedicine and in-person visits scheduled at our main outpatient clinic over a one-week period in June 2021 were retrospectively reviewed. Care visits with patients residing outside of the state were excluded. Travel distance and time calculations were estimated using Google Maps and based on patients’ reported home address. Travel cost was calculated using the IRS 2021 standard mileage rate of $0.56 per mile. Opportunity cost was calculated by multiplying round-trip travel time with estimated hourly wage, derived by median household income per census block group and in the context of a 40-hour work week. Annual projections were calculated by multiplying weekly cost savings by 52. RESULTS: A total of 156 patients had scheduled visits in our department over one week, 115 of which were via telemedicine. There was no difference in gender, race, ethnicity, and insurance status between telemedicine and in-person visits. Those attending telemedicine vs in-person visits were younger in age (61 vs 68 yrs, p=0.03). There was no significant difference between distance or time traveled to the cancer center between telemedicine and in-person cohorts. For telemedicine visits, median per-visit round-trip travel time saved was 66 minutes (IQR, 39-168 minutes) with a travel cost savings of $33.60 (IQR, $17.92 - $100.80), opportunity cost savings of $67.04 ($42.97 - $118.56), and overall cost savings of $110.57 (IQR, $59.94 - $202.04). Annually, telemedicine visits are estimated to save patients a total travel time of 12911.6 hours, travel costs of $402,684, opportunity costs of $530,588, and overall cost savings of $933,272. CONCLUSION: Telemedicine benefits patients with time- and cost-savings in an outpatient radiation oncology clinic. Our estimates are likely under-representative of the entire financial impact, as costs related to childcare, parking, tolls, hotels, and meals were not captured in our analysis. These unmeasured costs are likely amplified for those patients who live further from the clinic. Despite this, travel distance was not associated with utilization of telemedicine. In clinically appropriate situations, patient-centered metrics such time- and cost-savings should be considered when informing the choice between telemedicine and in-person visits.