de Mello-Sampayo Felipa
Department of Economics, Instituto Universitário de Lisboa (ISCTE-IUL) and BRU-IUL, ISCTE-IUL, cacifo 187, Av. Forças Armadas, 1649-026 Lisbon, Portugal.
Cost Eff Resour Alloc. 2019 Aug 23;17:18. doi: 10.1186/s12962-019-0186-3. eCollection 2019.
This study undertakes an economic analysis of presurgical teledermatology from a patient perspective, comparing it with a conventional referral system. Store-and-forward teledermatology allows surgical planning, saving both time and number of visits involving travel, thereby reducing patients' out-of-pocket expenses, i.e. costs that patients incur when traveling to and from health providers for treatment, visits' fees, and opportunity cost of time spent in visits. to The study quantifies the opportunity costs and direct costs of visits for adults waiting for dermatology surgery.
This study uses a retrospective assessment of 123 patients. Patients' out-of-pocket expenses of presurgical teledermatology were analyzed in the setting of a public hospital over 2 years. The teledermatology network covering the area served by the Hospital Garcia da Horta, Portugal, linked the primary care centers of 24 health districts with the hospital's dermatology department. The patients' opportunity cost of visits and direct costs of visits (transport costs, and visits' fee) of each presurgical modality (teledermatology and conventional referral), were simulated from initial primary care visit until surgical intervention. Two groups of patients, those with Squamous Cell Carcinoma and those with Basal Cell Carcinoma, were distinguished in order to compare the patients' out-of-pocket expenses according to the dermatoses.
From a patient perspective, the conventional system was 2.12 times more expensive than presurgical teledermatology. Teledermatology allowed saving €0.74 per patient and per day of delay avoided. This saving was greater in patients with Squamous Cell Carcinoma than in patients with Basal Cell Carcinoma. Although, the probabilistic sensitivity analysis corroborates the results of the base case scenario, only a prospective study can substantiate these results.
In the Portuguese public healthcare system and under specific cost hypotheses, from a patient economic perspective, teledermatology used for presurgical planning and preparation is the dominant strategy in terms of out-of-pocket expenses, outperforming the conventional referral system, especially for patients with severe dermatoses.
本研究从患者角度对术前远程皮肤病学进行经济分析，并将其与传统转诊系统进行比较。存储转发式远程皮肤病学有助于手术规划，节省时间和涉及出行的就诊次数，从而降低患者自付费用，即患者往返医疗服务提供者处接受治疗的费用、就诊费用以及就诊所花费时间的机会成本。本研究对等待皮肤科手术的成年人就诊的机会成本和直接成本进行了量化。
本研究对123例患者进行了回顾性评估。在一家公立医院的环境中，对术前远程皮肤病学患者的自付费用进行了为期2年的分析。覆盖葡萄牙加西亚·达奥尔塔医院服务区域的远程皮肤病学网络，将24个卫生区的初级保健中心与医院皮肤科相连。从最初的初级保健就诊到手术干预，模拟了每种术前模式（远程皮肤病学和传统转诊）患者的就诊机会成本和直接成本（交通成本和就诊费用）。区分了两组患者，即鳞状细胞癌患者和基底细胞癌患者，以便根据皮肤病比较患者的自付费用。
从患者角度来看，传统系统的费用是术前远程皮肤病学的2.12倍。远程皮肤病学可使每位患者和避免的每天延误节省0.74欧元。鳞状细胞癌患者的节省幅度大于基底细胞癌患者。尽管概率敏感性分析证实了基础病例情景的结果，但只有前瞻性研究才能证实这些结果。
在葡萄牙公共医疗系统和特定成本假设下，从患者经济角度来看，用于术前规划和准备的远程皮肤病学在自付费用方面是主导策略，优于传统转诊系统，尤其是对于患有严重皮肤病的患者。
