School of Pharmacy, University of Queensland, Brisbane, Australia.
Centre for Online Health, University of Queensland, Brisbane, Australia.
JAMA Dermatol. 2018 Jun 1;154(6):694-700. doi: 10.1001/jamadermatol.2018.0855.
International literature has shown that teledermoscopy referral may be a viable method for skin cancer referral; however, no economic investigations have occurred in Australia.
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.
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.
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.
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$318.39) vs usual care (A$263.75) was A$54.64 (95% CrI, A$22.69-A$97.35) per person. The incremental cost per day saved to clinical resolution was A$2.10 (95% CrI, A$0.87-A$5.29).
Using teledermoscopy for skin cancer referral and triage in Australia would cost A$54.64 extra per case on average but would result in clinical resolution 26 days sooner than usual care. Implementation recommendations depend on the preferences of the Australian health system decision makers for either lower cost or expedited clinical resolution. Further research around the clinical significance of expedited clinical resolution and its importance for patients could inform implementation recommendations for the Australian setting.
国际文献表明，远程皮肤镜检查转诊可能是一种可行的皮肤癌转诊方法；然而，澳大利亚尚未进行任何经济调查。
评估远程皮肤镜检查作为澳大利亚皮肤癌诊断和管理转诊机制的成本效益。
设计、设置和参与者：使用澳大利亚初级保健的决策分析模型进行成本效益分析，该模型由公开数据提供信息。
我们比较了远程皮肤镜检查转诊（包含数字皮肤镜图像的电子转诊）与常规护理（书面转诊信）对疑似皮肤癌的皮肤科专家评估的成本。
临床解决的成本和时间（以天为单位），其中临床解决定义为皮肤科医生诊断或全科医生切除。进行概率敏感性分析以检查主要结果的不确定性。
决策分析模型的结果表明，与单独常规护理（35 天，范围为 0-138 天）相比，远程皮肤镜检查转诊的平均临床解决时间为 9 天（范围为 1-50 天）（差异为 26 天；95%可信区间 [CrI]，13-38 天）。与常规护理相比，远程皮肤镜检查转诊（318.39 澳元）与常规护理（263.75 澳元）的估计平均成本差异为 54.64 澳元（95%CrI，22.69-97.35 澳元）。每节省一天临床解决的增量成本为 2.10 澳元（95%CrI，0.87-5.29 澳元）。
在澳大利亚，使用远程皮肤镜检查进行皮肤癌转诊和分诊平均每例额外花费 54.64 澳元，但比常规护理提前 26 天达到临床解决。实施建议取决于澳大利亚卫生系统决策者对降低成本或加快临床解决的偏好。进一步研究加快临床解决的临床意义及其对患者的重要性，可以为澳大利亚的实施建议提供信息。
