Impact of direct-to-consumer telemedicine consultations on follow-up consultations, episode costs, and antibiotic prescribing for upper respiratory tract infections in Sweden: An observational study

Background The use of direct-to-consumer (DTC) telemedicine has increased in recent years, with upper respiratory tract infections (URTIs) among the most common reasons for consultation. However, evidence on the impact of DTC telemedicine on healthcare utilisation, healthcare costs, and antibiotic prescribing remains limited. Objective To examine differences in follow-up consultations, episode costs, and antibiotic prescribing between DTC telemedicine and in-person episodes of care for URTIs in Swedish primary care. Methods We conducted a retrospective observational study using data from six Swedish regions in 2017–2018. Episodes initiated through DTC telemedicine were compared with those initiated through in-person physician consultations. Outcomes included follow-up physician consultations, antibiotic prescribing, and episode costs. Episode costs comprised production costs for in-person care, reimbursement for telemedicine consultations, including patient co-payments, and the cost of dispensed antibiotics for both episode types. Results The study included 523 647 patients (38 398 telemedicine episodes; 485 249 in-person episodes). Follow-up consultations were more frequent in telemedicine episodes, with an incidence rate ratio of 1.93 (95% CI 1.88–1.97). Episode costs were lower, with an adjusted difference of −121 US dollars (95% CI −122, −120), as lower initial consultation costs more than offset the higher rate of follow-ups. Antibiotic prescribing was also less frequent, with an odds ratio of 0.23 (95% CI 0.22–0.24). Conclusion In Swedish primary care, direct-to-consumer telemedicine for URTIs is associated with lower episode costs than in-person care, without higher antibiotic prescribing. However, lower episode costs do not necessarily imply lower total healthcare expenditure or cost-effectiveness.