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Review
. 2010 Aug 25:10:251.
doi: 10.1186/1472-6963-10-251.

A cost minimisation analysis in teledermatology: model-based approach

Nina Eminović  1 , Marcel G Dijkgraaf, Rosanne M Berghout, Astrid H Prins, Patrick Je Bindels, Nicolette F de Keizer
Affiliations
Review

A cost minimisation analysis in teledermatology: model-based approach

Nina Eminović et al. BMC Health Serv Res. .

Abstract

Background: Although store-and-forward teledermatology is increasingly becoming popular, evidence on its effects on efficiency and costs is lacking. The aim of this study, performed in addition to a clustered randomised trial, was to investigate to what extent and under which conditions store-and-forward teledermatology can reduce costs from a societal perspective.

Methods: A cost minimisation study design (a model based approach) was applied to compare teledermatology and conventional process costs per dermatology patient care episode. Regarding the societal perspective, total mean costs of investment, general practitioner, dermatologists, out-of-pocket expenses and employer costs were calculated. Uncertainty analysis was performed using Monte Carlo simulation with 31 distributions in the used cost model. Scenario analysis was performed using one-way and two-way sensitivity analyses with the following variables: the patient travel distance to physician and dermatologist, the duration of teleconsultation activities, and the proportion of preventable consultations.

Results: Total mean costs of teledermatology process were €387 (95%CI, 281 to 502.5), while the total mean costs of conventional process costs were €354.0 (95%CI, 228.0 to 484.0). The total mean difference between the processes was €32.5 (95%CI, -29.0 to 74.7). Savings by teledermatology can be achieved if the distance to a dermatologist is larger (> = 75 km) or when more consultations (> = 37%) can be prevented due to teledermatology.

Conclusions: Teledermatology, when applied to all dermatology referrals, has a probability of 0.11 of being cost saving to society.In order to achieve cost savings by teledermatology, teledermatology should be applied in only those cases with a reasonable probability that a live consultation can be prevented.

Trial registration: This study is performed partially based on PERFECT D Trial (Current Controlled Trials No. ISRCTN57478950).

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Figures

Figure 1
Figure 1
Graphical representation of the model where the choice is made between the conventional and teledermatological process. The key components of these processes are illustrated.
Figure 2
Figure 2
Distribution of the incremental costs of the teledermatological against conventional process as the reference case, following 10000 Monte Carlo simulations of 31 input distributions.
Figure 3
Figure 3
Total costs of teledermatology care and conventional care (Y-as) for different proportions of consultations prevented (X-as).
Figure 4
Figure 4
Total costs of the teledermatological and conventional process (Y-as) for different patient travel distances to GP (X-axis).
Figure 5
Figure 5
Total costs of the teledermatological and conventional process (Y-as) for different patient travel distances to dermatologist (X-axis).
See this image and copyright information in PMC

References

    1. Eminovic N, de Keizer NF, Bindels PJ, Hasman A. Maturity of teledermatology evaluation research: a systematic literature review. Br J Dermatol. 2007;156(3):412–419. doi: 10.1111/j.1365-2133.2006.07627.x. - DOI - PubMed
    1. Perednia DA, Wallace J, Morrisey M, Bartlett M, Marchionda L, Gibson A. et al.The effect of a teledermatology program on rural referral patterns to dermatologists and the management of skin disease. Medinfo. 1998;9(Pt 1):290–293. - PubMed
    1. Whitten PS, Mair FS, Haycox A, May CR, Williams TL, Hellmich S. Systematic review of cost effectiveness studies of telemedicine interventions. BMJ. 2002;324(7351):1434–1437. doi: 10.1136/bmj.324.7351.1434. - DOI - PMC - PubMed
    1. Whited JD. Teledermatology research review. Int J Dermatol. 2006;45(3):220–229. doi: 10.1111/j.1365-4632.2004.02427.x. - DOI - PubMed
    1. Eminovic N, de Keizer NF, Wyatt JC, ter Riet G, Peek N, van Weert HC. et al.Teledermatologic Consultation and Reduction in Referrals to Dermatologists: A Cluster Randomized Controlled Trial. Arch Dermatol. 2009;145(5):558–564. doi: 10.1001/archdermatol.2009.44. - DOI - PubMed

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