Department of Medical Informatics, Academic Medical Center-University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
BMC Health Serv Res. 2010 Aug 25;10:251. doi: 10.1186/1472-6963-10-251.
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.
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.
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.
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.
This study is performed partially based on PERFECT D Trial (Current Controlled Trials No. ISRCTN57478950).
尽管存储转发远程皮肤病学越来越受欢迎，但缺乏关于其对效率和成本影响的证据。本研究除了进行一项聚类随机试验外，旨在调查在何种程度和条件下存储转发远程皮肤病学可以从社会角度降低成本。
应用成本最小化研究设计（基于模型的方法）来比较每位皮肤病患者护理病例的远程皮肤病学和常规流程成本。从社会角度来看，计算了投资、全科医生、皮肤科医生、自付费用和雇主成本的总平均成本。使用蒙特卡罗模拟在使用的成本模型中使用 31 个分布进行不确定性分析。使用单向和双向敏感性分析进行情景分析，变量包括患者到医生和皮肤科医生的旅行距离、远程咨询活动的持续时间以及可预防咨询的比例。
远程皮肤病学流程的总平均成本为 387 欧元（95%CI，281 至 502.5），而传统流程成本的总平均成本为 354.0 欧元（95%CI，228.0 至 484.0）。两个流程之间的总平均差异为 32.5 欧元（95%CI，-29.0 至 74.7）。如果距离皮肤科医生较远（> = 75 公里）或由于远程皮肤病学可以预防更多的咨询（> = 37%），则可以通过远程皮肤病学实现节省。
如果所有皮肤科转诊都应用远程皮肤病学，那么从社会角度来看，远程皮肤病学具有 0.11 的概率可以节省成本。为了通过远程皮肤病学实现成本节约，只有在合理的情况下才能应用远程皮肤病学来预防面对面咨询。
本研究部分基于 PERFECT D 试验（当前对照试验编号 ISRCTN57478950）进行。
