Centaine Snoswell

Cost-effectiveness of Store-and-Forward Teledermatology: A Systematic Review

IMPORTANCE Teledermatology is a topical clinical approach being tested in Australia and elsewhere. With most dermatologists residing in metropolitan areas, teledermatology provides an apparent low-cost and convenient means of access for individuals living outside these areas. It is important that any proposed new addition to a health care system is assessed on the grounds of economic cost and effectiveness. OBJECTIVE To summarize and evaluate the current economic evidence comparing store-and-forward teledermatology (S&FTD) with conventional face-to-face care. EVIDENCE REVIEW Search terms with appropriate amendments were used to identify S&FTD articles that included economic analysis. Six databases were searched, and title, abstract and full-text reviews were conducted by 2 researchers. References of all unique returned articles were searched by hand. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to evaluate quality of the included articles. FINDINGS Eleven articles were selected for inclusion, including 1 cost analysis, 4 cost-minimization analyses, 4 cost-effectiveness analyses, and 2 cost-utility analyses. CHEERS scores ranged from 7 to 21 out of a possible 24 points, with a median score of 17. CONCLUSIONS AND RELEVANCE Current evidence is sparse but suggests that S&FTD can be cost-effective. It appears to be cost-effective when used as a triage mechanism to reduce face-to-face appointment requirements. The cost-effectiveness of S&FTD increases when patients are required to travel farther distances to access dermatology services. Further economic research is required for the emerging S&FTD, which uses dermoscopes in combination with smartphone applications, as well as regarding the possibility and consequences of patients self-capturing and transmitting images.

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

Importance 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

Economic evaluation strategies in telehealth: obtaining a more holistic valuation of telehealth interventions

318.39) vs usual care (A

Knowledge and attitudes of final year pharmacy students toward opioid substitution therapy

263.75) was A

Teledermoscopy as a Referral Method in Australia: A Decision Analytic Model

54.64 (95% CrI, A

What do Australian dermatologists expect to be paid for store-and-forward teledermoscopy? A preliminary investigation

22.69-A

Direct-to-consumer mobile teledermoscopy for skin cancer screening: Preliminary results demonstrating willingness-to-pay in Australia

97.35) per person. The incremental cost per day saved to clinical resolution was A

Checking of dispensed items by an Accuracy Checking Pharmacy Assistant: pre-pilot workflow changes (poster presentation)

2.10 (95% CrI, A

Teledermoscopy for skin cancer: what do dermatologists want to be paid to perform a consultation? (poster presentation)

0.87-A

Dermatologist remuneration expectations for store-and-forward teledermoscopy. (oral and poster presentation)

5.29). Conclusions and Relevance Using teledermoscopy for skin cancer referral and triage in Australia would cost A