To compare costs associated with teleurology vs face-to-face clinic visits for initial outpatient hematuria evaluation.

The analysis included 3 cost domains: transportation, clinic operations, and patient time. Transportation cost was based on standard government travel reimbursement. Clinic staff cost was based on hourly salary plus fringe benefits. For a face-to-face clinic encounter, patient time included time spent for travel, parking, walking to and from clinic, checking in and checking out, nursing evaluation, urologic evaluation, laboratory, and waiting. Patient time cost was based on the Federal minimum wage. Provider and laboratory times were excluded from the cost analysis as these were similar for both encounters.

We included 400 hematuria evaluations: 300 teleurology and 100 face-to-face. Both groups had similar median age (63 vs 64 years, P = .48) and median travel distance/time (58 vs 54 miles, P = .19; 94 vs 82 minutes, P = .09, respectively). Average patient time was greater for face-to-face encounters (266 vs 70 minutes teleurology, P < .001). Transportation was the primary driver of overall costs ($83.47 per encounter), followed by patient time ($32.87/encounter) and clinic staff cost ($18.68/encounter). The average cost per encounter was $135.02 for face-to-face clinic vs $10.95 for teleurology (P < .001) exclusive of provider and laboratory times. Cost savings associated with each telehematuria encounter totaled $124.07.

Teleurology offers considerable cost savings of $124 per encounter for the initial evaluation of hematuria compared to face-to-face clinic. With 1.5 million annual hematuria encounters nationally, implementation of teleurology for hematuria evaluation offers cost savings approaching $200 million per year.