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

Abstract

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

A service evaluation between 2‐week wait (2WW) skin cancer referrals via teledermatology and the standard face‐to‐face pathway at a teaching hospital

“…Teledermatology (TD) is often used to review skin cancer referrals. [1][2][3][4] A Cochrane review found that TD and faceto-face (F2F) review of skin cancer referrals had high levels of agreement for management decisions. 5 We compared waiting times and patient experience of a TD model with conventional F2F clinics.…”

“…An Australian study demonstrated that skin cancer referrals via TD concluded faster than those using the traditional model, and saved substantial travel costs for patients from rural areas. 4 Moreno-Ram ırez et al 7 noted that the proportion of lesions diagnosed as benign increased with a TD skin cancer model, suggesting the model increased referrals of benign lesions. However, more precancerous lesions and early/in situ melanomas were detected.…”

Consumer Acceptance and Expectations of a Mobile Health Application to Photograph Skin Lesions for Early Detection of Melanoma

“…These investigators determined that participants would be willing to pay up to AUD 110 for mobile teledermoscopy with a dermatologist reviewing the images [31]. The evidence suggests consumers are willing to adopt the technology, but further research is required to determine the accuracy of mobile teledermoscopy compared to face-to-face diagnosis [12]. …”

“…Mobile teledermoscopy uses a smartphone, an app to manage images, and an attachable dermatoscope to magnify and photograph skin lesions to remotely send to a dermatologist [10, 11]. These devices can be utilised as an efficient, low-cost communication tool between medical practitioners [12]. For example, a general practitioner can send images to a dermatologist for referral, or a nurse could image lesions as part of a triage system to reduce specialist waiting times and avoid substantial delays for urgent cases [13].…”

Using Advances in Skin Imaging Technology and Genomics for the Early Detection and Prevention of Melanoma

“…Mobile teledermoscopy has shown comparable diagnostic accuracy and agreement to in-person diagnoses for the lesions that the consumers elected to submit [4,5]. It has the potential to reduce waiting times and increase access to dermatologists [6][7][8][9].…”