Objective: This study evaluated cost, time, and mileage saved utilizing video-telemedicine during the initial pre-surgical evaluation for deep brain stimulation as treatment for tremor at San Francisco VA Medical Center (SFVA).

Background: The reasons for the existing disparities in surgical care amongst patient with tremor are complex, but one reason includes limited number of specialty facilities that offer the surgery. The SFVA receives referrals for DBS for the treatment of tremor from across large territory of the United States, including states as far as Minnesota, Indiana, and Michigan. The time, miles, and money spent traveling for initial in-person evaluation, and the savings incurred by using video telemedicine during initial surgical evaluation is unknown. 

Methods: This study is a retrospective cross-sectional study reviewing all out-of-state referrals to the SFVA from 2008 to 2013 for DBS therapy for the treatment of tremor. Out of a total of 148 initial pre-surgical DBS evaluations completed at SFVA, there were 60 out-of-state DBS referrals identified over the six-year period for surgical treatment of essential tremor or Parkinson disease. Of these, 24 patients underwent in-person DBS evaluation and 36 patients underwent initial consultation via video-telemedicine.  Based on the patients’ zip codes, the estimated hours, miles, and money spent traveling were calculated to and from appointments at the SFVA and their local VA where the video telemedicine appointment would be held.

Results: The average time, mileage, and cost of round-trip travel for a single in-person pre-surgical evaluation at SFVA per patient was 15.6 hours (range 9.5-27.8 hours), 2,938.7 miles (range 357- 4,165 miles), and $896 (range $350-$1,122). The average round-trip travel for a pre-surgical evaluation done utilizing video-telemedicine at patient’s local VA per patient was 1.4 hours (range 16 minutes-2.6 hours), 57.4 miles (range 8.8-323.5 miles), and $12.06 in travel cost (range $1.72-$16.59). Overall, the 36 patients in the video-telemedicine cohort saved an estimated total of 116,518 miles, 569.2 hours, and $33,246 in roundtrip travel during their initial pre-surgical evaluation.

Conclusions: The use of video telemedicine during the initial pre-surgical evaluation for deep brain stimulation saved veterans time, mileage, and money in travel when compared to traditional in-person evaluation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/saving-veterans-time-miles-and-money-cost-analysis-of-video-telemedicine-evaluation-of-deep-brain-stimulation-dbs-candidacy-at-the-va/