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

Datta, Santanu K.; Warshaw, Erin M.; Edison, Karen E.; Kapur, Kush; Thottapurathu, Lizy; Möritz, Thomas; Reda, Domenic J.; Whited, John D.

doi:10.1001/jamadermatol.2015.2362

Cited by 69 publications

(64 citation statements)

References 11 publications

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“…Greater diagnostic precision has depended on the enhanced quality of clinical images observed. 71,72 Within rural settings, results of three studies in this review indicated the importance of improved quality for diagnostic precision, whereas one study reported that clinical images might not provide sufficient insight to deliver clear-cut diagnoses. The central tenet of teledermatology has revolved around image clarity, and higher degrees of accuracy would undoubtedly assist in identifying the correct diagnosis.…”

Section: Discussionmentioning

confidence: 96%

Use of Teledermatology to Improve Dermatological Access in Rural Areas

Coustasse

Sarkar

Abodunde

et al. 2019

Telemedicine and e-Health

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Introduction: Dermatological access in rural regions has been impacted due to an acute, global dermatologist shortage coupled with a striking disparity in dermatologist density between urban and rural areas. As a result, the dermatological arena has been under notable pressure to amplify access. Teledermatology has entailed the use of technology to provide dermatological services to individuals located at a remote distance. The purpose of this literature review was to examine the effect of utilization of teledermatology to determine enhancement of dermatological access to residents of rural areas. Materials and Methods: This review followed a systematic approach and utilized five electronic databases to obtain peerreviewed journal articles. A PRISMA approach was used and a total of 86 references were employed. Results: Teledermatology programs have been able to complement conventional dermatological care to enhance dermatological access to rural areas that have suffered from a shortage of dermatologists and could aid in supplementing traditional care as well. Within rural settings, the results of three studies in this review indicated the importance of improved quality for diagnostic precision, whereas one study reported that clinical images might not provide sufficient insight to deliver clear-cut diagnoses. In addition, enhancements in diagnostic precision could be obtained by upgrades in phone cameras to capture images. Finally, to most of the existing literature, in using teledermatology, physician satisfaction has been stronger than patient satisfaction. Conclusions: Teledermatology has had a beneficial impact in improving dermatological access to rural areas. The success of this technology is contingent upon the commitment and willingness of the dermatologist in utilizing it.

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Section: Discussionmentioning

confidence: 96%

Use of Teledermatology to Improve Dermatological Access in Rural Areas

Coustasse

Sarkar

Abodunde

et al. 2019

Telemedicine and e-Health

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“…Consistent with our findings, studies in other countries have demonstrated that teledermoscopy services were of comparable or higher cost vs usual care with positive benefits. 10,14,[24][25][26] Internationally, teledermoscopy referral systems have been successfully piloted with benefits similar to those demonstrated by this model. [8][9][10] These studies showed that when used as a referral method, teledermoscopy meant that 39% to 88% of patients did not have to attend an inperson consultation with their dermatologist and were able to Probability that after teledermatology the patient be referred back to GP for management Time (d) from GP visit to final resolution (excision or dermatologist appointment) in usual care…”

Section: Discussionmentioning

confidence: 93%

Cost-effectiveness of Skin Cancer Referral and Consultation Using Teledermoscopy in Australia

et al. 2018

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International literature has shown that teledermoscopy referral may be a viable method for skin cancer referral; however, no economic investigations have occurred in Australia. OBJECTIVE To assess the cost-effectiveness of teledermoscopy as a referral mechanism for skin cancer diagnosis and management in Australia. DESIGN, SETTING, AND PARTICIPANTS Cost-effectiveness analysis using a decision-analytic model of Australian primary care, informed by publicly available data. INTERVENTIONS We compared the costs of teledermoscopy referral (electronic referral containing digital dermoscopic images) vs usual care (a written referral letter) for specialist dermatologist review of a suspected skin cancer. MAIN OUTCOMES AND MEASURES Cost and time in days to clinical resolution, where clinical resolution was defined as diagnosis by a dermatologist or excision by a general practitioner. Probabilistic sensitivity analysis was performed to examine the uncertainty of the main results. RESULTS Findings from the decision-analytic model showed that the mean time to clinical resolution was 9 days (range, 1-50 days) with teledermoscopy referral compared with 35 days (range, 0-138 days) with usual care alone (difference, 26 days; 95% credible interval [CrI], 13-38 days). The estimated mean cost difference between teledermoscopy referral

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“…However, there is a general trend in different regions and among large private payers toward reimbursing telehealth services that show value. We keenly recognize that the field of economic evaluation for telehealth models continues to evolve (Armstrong et al, 2007;Datta et al, 2015;de la Torre-Díez et al, 2015). Future studies shall include cost analyses that evaluate the economic impact of telehealth interventions from a societal perspective.…”

Section: Discussionmentioning

confidence: 99%

Online Care Versus In-Person Care for Improving Quality of Life in Psoriasis: A Randomized Controlled Equivalency Trial

Armstrong

Ford

Chambers

et al. 2019

Journal of Investigative Dermatology

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This 12-month, pragmatic, randomized controlled equivalency trial evaluated whether an online, collaborative connected-health model results in equivalent improvements in quality of life compared with in-person care for psoriasis. Overall, 296 adults with physician-diagnosed psoriasis from ambulatory clinics were randomly assigned to either online or in-person care; all were analyzed for outcomes. In the online group, patients and primary care providers sought dermatologists' care directly and asynchronously online. The in-person group sought care face to face. Interventions did not allow blinding of participants; investigators were blinded during analysis. Across 12 months, for the online group, the mean AE standard deviation decline in Skindex-16 from baseline across follow-up visits was 9.02 AE 20.67 compared with 10.55 AE 23.50 for the in-person group. The difference in Skindex-16 between the two groups was e0.83 (95% confidence interval ¼ e5.18 to 3.51), and this was within the equivalence margin (AE7.0). For the online group, the mean AE standard deviation decline in Dermatology Life Quality Index was 1.64 AE 4.34 compared with 1.18 AE 4.77 for the in-person group. The difference in Dermatology Life Quality Index between the two groups was e0.45 (95% confidence interval ¼ e1.29 to 0.38) and was within the equivalence margin (AE2.5). In conclusion, the online model was as effective as inperson care in improving quality of life among psoriasis patients. This study was funded by the Patient-Centered Outcomes Research Institute and is registered on clinicaltrials.gov (NCT02358135).

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

Cited by 69 publications

References 11 publications

Use of Teledermatology to Improve Dermatological Access in Rural Areas

Use of Teledermatology to Improve Dermatological Access in Rural Areas

Cost-effectiveness of Skin Cancer Referral and Consultation Using Teledermoscopy in Australia

Online Care Versus In-Person Care for Improving Quality of Life in Psoriasis: A Randomized Controlled Equivalency Trial

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