Cost analysis of a store-and-forward teledermatology consult system in Philadelphia

Abstract

Background: Store-and-forward (SAF) teledermatology (TD) has the potential to increase access to timely, high-quality care for underserved populations. However, the cost-effectiveness of TD for underserved populations is uncertain.

Objective: This study evaluates the potential cost savings associated with an SAF TD program implemented for an underserved population in the city health clinics of urban Philadelphia.

Methods: We performed a retrospective analysis of SAF TD consultations for 700 outpatients managed in 12 Philadelphia primary care clinics. Primary care providers were asked to specify a treatment plan, as well as the type of care for the patient, in the absence of the TD service. Analysis compared the cost of each patient case with use of the TD consult model versus with conventional care.

Results: In all, 27% of in-person dermatology clinic visits (189 of 700) and 3.29% of emergency room visits (23 of 700) were avoided by using TD. Compared with conventional care, TD had a mean expected cost savings of $10.00 to $52.65 per TD consult. In sensitivity analyses, these estimated savings remained positive across a range of parameters.

Limitations: The cost analysis relies on several assumptions regarding the cost of care, and indirect costs were not included.

Conclusion: TD can be a cost-saving model while increasing access to dermatologic care.

Keywords: access to care; cost analysis; dermatology; mHealth; store-and forward; teledermatology.