**A Cost-Minimization Analysis of a Medical Record-based, Store and Forward and Provider-to-provider Telemedicine Compared to Usual Care in Catalonia: More Agile and E**ffi**cient, Especially for Users**


Received: 23 January 2020; Accepted: 17 March 2020; Published: 18 March 2020

**Abstract:** Background: Telemedicine (interconsultation between primary and hospital care teams) has been operating in the counties of Central Catalonia Bages, Moianès and Berguedà since 2011, specializing in teledermatology, teleulcers, teleophthalmology and teleaudiometries. For the period until the end of 2019, a total of 52,198 visits were recorded. Objective: To analyze the differential costs between telemedicine and usual care in a semi-urban environment. Methodology: A cost-minimization evaluation, including direct and indirect costs from a societal perspective, distinguishing healthcare and user's costs, was carried out over a three-month period. Results: Telemedicine saved € 780,397 over the period analyzed. A differential cost favorable to telemedicine of about € 15 per visit was observed, with the patient being the largest beneficiary of this saving (by 85%) in terms of shorter waiting times and travel costs. From the healthcare system perspective, moving the time spent in a hospital care consultation to primary care is efficient in terms of the total time devoted per patient. In social terms and in this context, telemedicine is more efficient than usual care. Conclusion: Allowing users to save time in terms of consultation and travel is the main driver of interconsultation between primary and hospital care savings in a semi-urban context. The telemedicine service is also economically favorable for the healthcare system, enabling it to provide a more agile service, which also benefits healthcare professionals.

**Keywords:** cost analysis; health technology assessment; provider-to-provider telemedicine; telehealth; economic analysis

**Francesc <sup>L</sup>ópez Seguí 1,2, Jordi Franch Parella 3, Xavier Gironès García 3, Jacobo Mendioroz Peña 4,5, Francesc García Cuyàs 6, Cristina Adroher Mas 6, Anna García-Altés 7 and Josep Vidal-Alaball 4,5,\***
