Cost Analysis of Telehealth as Initial Visit Type for Infantile Hemangioma in the United States

Background: Hemangiomas are the most common soft-tissue tumors of infancy affecting 4-5% of all neonates with 15% resulting in complications that require medical treatment. The purpose is to assess cost-effectiveness of initial management of infantile hemangiomas via Telehealth (TH) compared to an in-person (IP) visit.

Methods: Decision models were constructed in TreeAge Pro 2020 to compare the implications of conducting an initial consultation for potential hemangioma via TH versus the standard IP consultation modality. Infant patients referred for consultation are assumed to be in one of three biological states: hemangioma, other (“non-serious”) condition, or other (“serious”) condition. If a given patient was in the “hemangioma” or “other serious condition” state, providers could either make or miss the diagnosis. We assumed patients choosing either visit type were balanced on all characteristics. (Figure 1). Probabilities based on the existing literature and expert opinion were associated with each outcome. Payoffs were associated with each outcome; reimbursement values were extracted from Medicare data and economic estimates of indirect costs (travel and lost time). The expected value of patient visits were calculated in the model, and the lower expected cost was considered optimal. Expected values were calculated under two perspectives: a patient/payer perspective and a “societal” (patient/payer/provider) perspective, the former assuming TH and IP visits would be equally reimbursed, and the latter incorporating the estimated cost saving arising from lower overhead costs if Telehealth visits were widely adopted. Total and percentage cost savings associate with Telehealth consultations versus the In-person status quo were calculated under each perspective. Deterministic sensitivity analysis was conducted to assess the most salient model inputs.

Results: After accounting for increased risk of missed hemangioma and serious condition diagnoses, from a patient (payer) perspective, TH (expected cost: $252.78) as an initial visit modality for infantile hemangiomas is associated with $11.43 in expected cost savings, as compared to in-person initial visits (expected cost: $264.21). From a societal perspective (after accounting for long-term cost-savings from lower overhead costs in TH), TH as an initial visit modality is associated with $56.43 in cost savings. Thus, in comparison to IP, TH is associated with 4.33% and 21.36% cost savings from the payer and societal perspectives, respectively. The most salient model inputs for these estimates are the additional costs of IP visits (transportation and lost time) and the probability of missed hemangioma diagnoses in the IP setting.

Conclusion: The use of Telehealth for initial hemangioma consultation compared to in-patient office visits proved to be efficient and cost-effective from both a payer/ patient and societal perspective. We anticipate the savings to continue with follow-up visits, especially as the use of telehealth in pediatrics continues to grow.