A cost-consequence analysis comparing patient travel, outreach, and telehealth clinic models for a specialist diabetes service to Indigenous people in Queensland

Introduction The delivery of specialist health services to people living in Indigenous communities is an important challenge. Specialist diabetes outpatient clinics may be delivered via a patient travelling to a metropolitan hospital, during an outreach clinic, or by telehealth. The aim of this study was to compare the costs and consequences of different service models for delivering specialist diabetes clinics for a remote Indigenous community. Method Patient travel, outreach and telehealth clinic models were compared using a cost-consequence analysis principles. The setting was Cunnamulla, a remote Indigenous community in Western Queensland. Costs were calculated by quantifying the staff resources and travel costs for each clinic model. Costs were reported in Australian dollars and reported from the health service perspective. Results The marginal cost per patient for each clinic were $692 for patient travel, $482 for the outreach and $284 for telehealth. If a patient travel appointment was replaced with telehealth, approximately $517 in costs for patient travel reimbursement would be avoided. While replacing an entire outreach clinic with a telehealth clinic would reduce costs by approximately $3961. Conclusion The marginal cost of patient travel to a metropolitan clinic and outreach clinic appointments was greater than telehealth. Telehealth is unlikely to completely replace the need for patient travel or outreach clinics. However, replacing a proportion of these appointments with telehealth may reduce the overall costs of providing specialist diabetes care in remote communities. Telehealth may have advantages beyond economic as it reduces the time away from usual activities for both the patient and endocrinologist.