Paying the price of distance: Financial cost and carbon footprint analyses for neurosurgical follow-up in remote pacific Islands.

CONTEXT: Neurosurgical care in the South Pacific islands is highly centralized in a single tertiary referral center. The archipelagic geography of these territories imposes substantial transportation requirements for postoperative follow-up visits. This study aimed to estimate the economic and environmental burden associated with in-person neurosurgical follow-up consultations and to evaluate the potential of telemedicine as a cost-and carbon-saving alternative.

METHODS

All consecutives patients who underwent a neurosurgical procedure in our department between February 1, 2024, and February 1, 2025, were screened. Patients residing more than 3 h away from the neurosurgical unit (defined as ≥ 200 km by road) or requiring air transportation, and who attended postoperative follow-up consultations were retrospectively included. All costs generated by in-person visits were estimated (in Euros and USD) using a micro-costing approach based on observed resource utilization and standardized unit costs. Carbon emissions were estimated using the ADEME (French Agency for Ecological Transition) database and focused on emissions related to patient transportation. Emissions were expressed in kilograms of carbon dioxide equivalent (kgCO2eq).

RESULTS

One hundred patients were included, representing a total of 200 in-person follow-up visits. The estimated total financial cost of these in-person visits was 129,400 USD (111,631 Euro), which mean an average of 647 USD/558,15 Euro per patient, shared by the Public Health Office and families. The mean estimated carbon footprint is 138.4 kgCO2eq per patient. Depending on the mode of transport, the estimation varies from 90 to 732 kgCO2eq.

CONCLUSION

Our findings indicate that geographical distance inherent to archipelagic settings generates a substantial financial and environmental burden for neurosurgical follow-up care. In this context, telemedicine represents a highly relevant strategy to reduce unnecessary travail, improve access to care, and achieve meaningful cost and carbon savings in remote island territories.