Lovén Maria, Huilaja Laura, Paananen Markus, Torkki Paulus
Department of Public Health, The University of Helsinki, Helsinki, Finland.
Mehiläinen Länsi-Pohja, Kemi, Finland.
J Eur Acad Dermatol Venereol. 2024 Dec 2. doi: 10.1111/jdv.20451.
The management of patients with skin changes can be challenging in primary healthcare; general practitioners (GPs) often lack the expertise to make accurate assessments and treatment decisions. The standard care pathway for skin changes can result in extended treatment times and costs.
This study was designed to evaluate the cost-effectiveness of integrating a dermatologist into the primary care setting to assess and treat patients with skin disorders. The primary outcome was the incremental cost-effectiveness ratio (ICER) for each malignant or pre-malignant skin disease found and treated. The secondary outcomes included ICER for any treated skin finding, number needed to excise to find malignant or pre-malignant skin disease, number of hospital referrals required and changes in quality of life (QoL) in the presence and absence of the integration.
This was a quasi-experimental cohort study conducted at three primary healthcare centres in Finland. In the two intervention centres, patients with skin findings visited a dermatologist; in the control centre they visited a GP. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). QoL was assessed with the PROMIS v1.2, calculative EQ-5D-3L and PROMIS Anxiety 4a instruments.
In total, 186 integration and 176 control patients were included. For an additional patient treated for a (pre-)malignant skin disease, the ICER was €852 lower and with any skin disease €381 lower in the integration group than with standard care. Fewer biopsies were required for each malignant or pre-malignant skin disease in the integration group compared to the control group (2.1 and 6.5 per patient; p < 0.001) and lower proportion of patients were referred to hospital (8.1 vs. 17.1%, p < 0.001). Patient QoL did not differ between groups.
The integration of dermatological expertise into primary care settings is cost-effective and can streamline the management of patients with skin conditions without worsening their QoL.
在初级医疗保健中，对皮肤病变患者的管理可能具有挑战性；全科医生（GPs）往往缺乏进行准确评估和治疗决策的专业知识。皮肤病变的标准护理途径可能导致治疗时间延长和成本增加。
本研究旨在评估将皮肤科医生纳入初级保健机构以评估和治疗皮肤疾病患者的成本效益。主要结局是发现并治疗的每种恶性或癌前皮肤疾病的增量成本效益比（ICER）。次要结局包括任何治疗的皮肤病变的ICER、发现恶性或癌前皮肤疾病所需切除的数量、所需的医院转诊数量以及有或没有整合情况下的生活质量（QoL）变化。
这是一项在芬兰三个初级医疗保健中心进行的准实验队列研究。在两个干预中心，有皮肤病变的患者就诊于皮肤科医生；在对照中心，他们就诊于全科医生。使用增量成本效益比（ICER）评估成本效益。使用PROMIS v1.2、计算性EQ-5D-3L和PROMIS焦虑4a工具评估生活质量。
总共纳入了186名整合组患者和176名对照组患者。与标准护理相比，整合组中每多治疗一名患有（癌前）恶性皮肤疾病的患者，ICER低852欧元，每多治疗一名患有任何皮肤疾病的患者，ICER低381欧元。与对照组相比，整合组中每种恶性或癌前皮肤疾病所需的活检次数更少（每位患者分别为2.1次和6.5次；p < 0.001），转诊至医院的患者比例更低（8.1%对17.1%，p < 0.001）。两组患者的生活质量没有差异。
将皮肤科专业知识纳入初级保健机构具有成本效益，并且可以简化皮肤疾病患者的管理，而不会恶化他们的生活质量。
