An Economic Analysis of a Store and Forward Teledermatology Consult System

Abstract

Our objective was to assess the economic impact of store-and-forward teledermatology in a United States Department of Veterans Affairs (VA) health care setting. Patients being referred to the Dermatology Consult Service from the Primary Care Clinics at the Durham, North Carolina VA Medical Center were randomized either to usual care or to a teledermatology consultation. Fixed and variable costs for both consult modalities were identified using a microcosting approach. The observed clinical outcomes from the randomized trial generated probability and effectiveness measures that were inserted into a decision model. A cost analysis and a cost-effectiveness analysis that compared the two consult modalities was performed. Teledermatology was not cost saving when compared to usual care using observed costs and outcomes. Sensitivity analyses indicated that teledermatology has the potential to be cost saving if clinic visit costs, travel costs, or averted clinic visits were higher than observed in the study. Teledermatology was cost-effective for decreasing the time required for patients to reach a point of initial definitive care. Cost-effectiveness ratios ranged from $0.12-0.17 (U.S.) per patient per day of time to initial intervention.

Cost and Utility Analysis of a Store-and-Forward Teledermatology Referral System

“…A prior study performed in a VA 12 setting resulted in cost findings contrary to our findings. In that study, store-and-forward teledermatology was the more costly alternative, with the mean cost per participant for teledermatology of $36.40 vs $21.40 for conventional referral from the VA perspective.…”

Store-and-Forward Teledermatology in Skin Cancer Triage

“…13 Mean waiting intervals reported in studies evaluating TD systems have ranged between 2 and 50 days for TD systems vs the 88 to 137 days demonstrated by the conventional letter referral. 2,[14][15][16] In our series, patients referred to the clinic, one third of whom had malignant lesions, were attended to within the following 2 weeks (mean time, 12.31 days) since they first visited the general practitioner, in accordance with the 2-week rule promoted by health care administrations. 6,7 Along with the faster communication channel that the Internet represents, the avoidance of unnecessary visits to the dermatologist may explain such shortening of waiting intervals.…”

Teledermatology: Outcomes and Economic Considerations

“…While studies differed in their economic perspective and modality of S&F teledermatology delivery (e.g. triage, consultation, versus provision of care), analyses have generally established that S&F teledermatology offers a cost-effective means of providing dermatologic care especially for those living in geographically isolated communities or medically underserved communities (Pak et al, 2009;Whited et al, 2003). For example, in a cost-minimization analysis that adopted the perspective of the U.S. Department of Defense, Pak et al concluded that the use of teleconsultations through S&F technology reduced overall costs compared to conventional care (Pak et al, 2009).…”

“…For example, in a cost-minimization analysis that adopted the perspective of the U.S. Department of Defense, Pak et al concluded that the use of teleconsultations through S&F technology reduced overall costs compared to conventional care (Pak et al, 2009). Similarly, Whited et al performed a cost analysis of a consultative model using S&F technology from the perspective of the U.S. Department of Veterans Affairs (Whited et al, 2003). The authors found that teleconsultations are $15 more costly per patient compared to face-to-face consultation.…”

“…They found that having teledermatology consultations resulted in shorter timeto-specialist evaluation and was overall more cost-effective. Further analyses showed that, from a societal perspective, S&F teleconsultations would be even less costly after accounting for patients' travel time and productivity lost through face-to-face care (Whited et al, 2003). When S&F teledermatology was used as a primary method for triaging cases appropriate face-to-face encounters, researchers found that this was an economically viable means for prioritizing patients requiring dermatologic care (Ferrandiz et al, 2008;Moreno-Ramirez et al, 2009).…”