ABC | Volume 113, Nº5, November 2019

Guidelines Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology – 2019 Arq Bras Cardiol. 2019; 113(5):1006-1056 Table 5.3 – Comparison of costs between the alternatives remote report and face-to-face report in the Minas Telecardio Project 278 Scenario Cost (R$) Difference (R$) 1. Remote report 28.92 2. Face-to-face report without costs of patient displacement 30.91 1.99 3. Face-to-face report with costs of patient displacement 49.83 20.91 Table 5.2 – Results of comparison: treatment of hypertensive patients with conventional care through Telemedicine and through a structured telephone support system over a 30-year timeframe from 2015 Conventional care Telemedicine Structured telephone support Total cost (R$) 5,832 55,930 49,870 Incremental cost (R$) 50,098 44,038 Additional life-years 1 1.89 1.61 Cost per additional life-year (R$/year) 26,437 27,281 1 Additional life-years reflect the impact of longevity on the patient’s quality of life. to Brazilian law, products, medications, or procedures included in SUS’ protocols must be evaluated for safety, efficacy, effectiveness, and cost effectiveness. Therefore, an effective reference is still needed to validate the economic assessment in question. 277 5.6. Telediagnosis and Teleconsultation System of the Minas Gerais Teleassistance Network (Rede de Teleassistência de Minas Gerais, RTMG) at the Clinics Hospital of UFMG The Telehealth Center ( Centro de Telessaúde , CTS HC/ UFMG) coordinates the RTMG, a collaborative network established in 2005 by seven public universities in Minas Gerais: UFMG, Federal University of Uberlândia (UFU), Federal University of Triângulo Mineiro (UFTM), Federal University of Juiz de Fora (UFJF), Federal University of São João Del Rei (UFSJ), State University of Montes Claros (Unimontes), and Federal University of Jequitinhonha and Mucuri Valleys (UFVJM). Telecare activities include teleconsultation and telediagnosis. Teleconsultations are mostly asynchronous through regulatory calls in medicine, nursing, dentistry, physiotherapy, pharmacy, psychology, nutrition, and speech therapy. Telediagnosis consists of the analysis and reports of ECGs, ABPM, Holter, and retinography, along with synchronous cardiology teleconsultations to support critical clinical cases. The service is registered in the CRM of the State of Minas Gerais. The RTMG activity was initiated with the research project Minas Telecardio in 2006, implementing a telecardiology service with ECG reports and teleconsultation in 82 municipalities in Minas Gerais. The RTMG activities expanded over time and currently connects 814 municipalities with more than 1,000 telehealth units in Minas Gerais. Within the ONTD project of the Ministry of Health, it began to offer nationwide telecardiology services on September 2017, and currently serves 90 municipalities in the states of Acre, Bahia, Ceará, Mato Grosso and Roraima. This expansion was partly the result of studies proving the cost effectiveness of the system for the main RTMG funders (Ministry of Health and Minas Gerais State Department of Health). Using the results of the Minas Telecardio Project, Andrade et al. 278 compared the cost-benefit ratio of remote ECG reporting, considering the hypothesis of economic benefit in performing ECGs in the telecardiology project compared with the referral of the patient to perform ECG examination at another location. 278 The study was conducted between June 2006 and November 2008 in 82 municipalities in rural areas of the state of Minas Gerais. Each municipality received a microcomputer with a digital electrocardiograph machine and had the possibility of forwarding the ECG recordings and establishing communication with the cardiology department at university hospitals of the RTMG. The costs of the project were divided into two categories: related to the implementation and related to the maintenance of the telecardiology system. The cost of moving patients was assessed, including the cost of transportation (using city-provided resources), the cost of food during their absence from home, and the cost of a missed working day (both paid by the patient). The cost-benefit without inclusion (perspective of the public health service) and with inclusion (perspective of the society) of the patients’ costs were evaluated. For the face-to-face scenario, the cost of ECG and cost of the consultation were added (R$ 5.15 and R$ 10.00, respectively, based on the SUS’ reference table). The sources of data for the analysis were mainly the National Household Sample Survey ( Pesquisa Nacional de Amostra de Domicílios , PNAD), SIA-SUS Ambulatory Information System, and CNES. Considering the cost of implementation and maintenance of the project of R$ 1,818,282.87 and the number of examinations performed in the 30-month period (62,865 examinations from August 2006 to December 2008), the unit cost of each remote report was R$ 28.92. A summary of the results is shown in Table 5.3. A sensitivity analysis showed that the results are sensitive to patient travel costs, particularly related to the driver’s salary and number of patients per vehicle. Given the small difference between scenarios 1 and 2, it can be concluded that, in some situations, telecardiology may not be more economical from the point of view of public health service. At that time, the system had a relatively low output and, since the activities have a high fixed cost, resulted in a high cost for the remote report. With the expansion of the system to other municipalities, the cost of the activities reduced, increasing the cost effectiveness of the system. In 2007, the Ministry of Health, with resources from PAHO, engaged the CTS HC/UFMG in the project “Analysis of the Financial Management of Telehealth Services Applied 1042