Open Access

Bottom-Up Analysis of Telemonitoring Costs: A Case Study in Slovenian Primary Care

Matic MIHEVC
Matic MIHEVC
, 
Črt ZAVRNIK
Črt ZAVRNIK
, 
Majda MORI LUKANČIČ
Majda MORI LUKANČIČ
, 
Tina VIRTIČ POTOČNIK
Tina VIRTIČ POTOČNIK
, 
Marija PETEK ŠTER
Marija PETEK ŠTER
, 
Zalika KLEMENC-KETIŠ
Zalika KLEMENC-KETIŠ
 and 
Antonija POPLAS SUSIČ
Antonija POPLAS SUSIČ
   | Jan 03, 2024
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Article Category: Original scientific article
Published Online: Jan 03, 2024
Page range: 5 - 13
Received: Sep 15, 2023
Accepted: Nov 23, 2023
DOI: https://doi.org/10.2478/sjph-2024-0002
Keywords
© 2024 Matic MIHEVC et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1.

CONSORT flow diagram illustrating the randomisation process.
CONSORT flow diagram illustrating the randomisation process.

Baseline socio-demographic and clinical data.

Variable All patients (N=117) Telemonitoring (N=55) Standard care (N=62) P
Age, years, mean (SD) 71.4±4.7 70.6±4.3 72.0±5.0 0.123
Sex
Male (N) 71 34 37 0.813
Female (N) 46 21 25
Highest education achieved
Primary school (N) 18 7 11 0.518
Vocational school (N) 69 33 36
High school (N) 16 10 6
Bachelor’s degree (N) 10 3 7
Master’s degree (N) 4 2 2
Region
Urban (N) 54 27 27 0.548
Rural (N) 63 28 35
Marital status
Married (N) 86 41 45 0.527
Divorced (N) 8 2 6
Widowed (N) 5 2 3
Single (N) 18 10 8
Clinical data
Duration of type 2 diabetes, years, mean (SD) 9.5±7.6 9.8±6.3 9.2±8.6 0.672
Duration of hypertension, years, mean (SD) 14.5±10.6 13.7±10.6 15.2±10.6 0.667
Systolic blood pressure, mmHg, mean (SD) 136.7±14.1 135.8±14.9 137.7±13.1 0.458
Diastolic blood pressure, mmHg, mean (SD) 76.5±8.2 75.6±7.0 77.2±9.0 0.280
Glycated haemoglobin, %, mean (SD) 7.2±1.0 7.2±1.2 7.1±0.8 0.411

Breakdown of operational costs per patient.

Cost subcategory Mean annual time per action (min, 95% CI) Gross value per hour (EUR) Mean annual gross costs per patient (EUR, 95% CI)
Patient training 82(75-89) 10.3 14.1(12.9-15.3)
Data review 201(178-225) 20.9 70.0(62.0-78.4)
Teleconsultations 38(31-44) 20.9 13.2(10.8-15.3)
Mean annual total gross costs (EUR, 95% CI) / / 97.3(85.7-109.0)

Comparison of out-of-pocket costs across groups.

Cost subcategory All patients (N=117), mean (min, max) Telemonitoring(N=55), mean (min, max) Standard care (N=62), mean (min, max) P
Transportation and parking (EUR) 27 (0-1,200) 9 (0-180) 43 (0-1,200) 0.149
Food and dietary supplements (EUR) 151 (0-2,400) 83 (0-2,400) 214 (0-2,400) 0.015
Exercise and fitness (EUR) 38 (0-1,440) 20 (0-480) 56 (0-1,440) 0.784
Education (EUR) 1 (0-60) 0 (0-0) 1 (0-60) 0.334
Rehabilitative services (EUR) 20 (0-840) 0 (0-0) 39 (0-840) 0.050
Out-of-pocket checkups (EUR) 23 (0-900) 0 (0-0) 45 (0-900) 0.016
Medical devices (EUR) 56 (0-1,200) 9 (0-72) 101 (0-1,200) <0.001
Customised footwear (EUR) 6 (0-180) 2 (0-50) 10 (0-180) 0.198
Miscellaneous (EUR) 23 (0-1,200) 9 (0-480) 36 (0-1,200) 0.972
Mean annual total costs (EUR, 95% CI) 345 (221-469) 132 (32-231) 545 (332-757) <0.001

Breakdown of telemonitoring costs from various perspectives.

Perspective Category Cost subcategory Definition
Healthcare provider Infrastructure costs Equipment acquisitionEquipment maintenanceEquipment depreciationTelemedicine platform subscription Costs for obtaining necessary devicesOngoing costs for device functionality and long service lifeCosts of spreading equipment cost over its service lifeCosts covering technology infrastructure, data security, and user support for telemonitoring and video calls
Healthcare provider Operational costs Patient training investmentCost of data review by coordinator Teleconsultation costs Initial costs for patient training to ensure proper device usageLabour costs for the analysis of patient data Labour costs for conducting teleconsultations
Patient or society Patient participation costs Training time costsMeasurements time costsTeleconsultation time costs Costs associated with training in device usageCosts for BP and BG measurement timeCosts for teleconsultation sessions Costs related to travel
Patient or society Change in out-ofpocket costs Transportation and parking Food and dietary supplement Exercise and fitness EducationRehabilitative services Out-of-pocket checkups Medical devices Customised footwear Costs for dietary needs Costs for physical activity Costs for educational materials or programmes Costs for rehabilitation or physiotherapyCosts for non-covered or quicker checkups at private institutions Costs for monitors and BG strips Costs for specialised diabetes footwear

Breakdown of participation costs per patient.

Cost subcategory Mean annual time per action (min, 95% Ci) Gross value per hour (EUR) Mean annual gross costs per patient (EUR, 95% CI)
Patient training 82(75-89) 11.5 15.7(14.4-17.1)
Data review 1,005(890-1,125) 11.5 192.6(170.6-215.6)
Teleconsultations 38(31-44) 11.5 7.3(5.9-8.4)
Mean annual total gross costs (EUR, 95% CI) / / 215.6(190.9-241.1)
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