Cost-effectiveness of an acute medical teleconsultation model for nursing home residents

Background and Objectives: Emergency department (ED) transfers and unplanned hospital admissions of nursing home residents are common and costly. This study evaluated the cost-effectiveness of a hospital-managed acute medical teleconsultation service (EAGLEcareACT) in reducing ED transfers and hospital admissions among nursing home residents in Singapore. Currently, the teleconsultation service is provided free of charge to nursing home residents. Research Design and Methods: A decision-tree model compared the EAGLEcareACT pathway with usual care from the healthcare institution's perspective. Clinical outcomes were obtained from service data (2022 to 2023). Both deterministic and probabilistic sensitivity analyses (PSA) were performed. Cost-effectiveness was further assessed using net monetary benefit (NMB) under Singapore willingness-to-pay thresholds. Results: The base-case analysis showed that EAGLEcareACT was cost-saving, with an incremental cost savings of 444.04 Singapore Dollars per unplanned hospital admission avoided, when compared with usual care. The PSA showed the model was both less costly and more effective. The NMB remained positive across all plausible Quality-Adjusted Life Year assumptions, with 97% probability being cost-effective. Discussion and Implications: The acute medical teleconsultation service model, as a cost-saving and cost-effective in avoiding ED transfers and unplanned hospital admissions among nursing home residents, demonstrated potential for scalability.