A cost-minimization analysis of a realtime teledermatology service in northern Norway.

Realtime teledermatology has been a routine service provided by the University Hospital of Tromsø to a primary-care centre in Kirkenes since 1989. The cost of the teledermatology service was compared with the costs of three alternative methods of treatment for the patients. The first was a combination of a visiting service and patient travel to hospital. The second was patient travel to the nearest secondary-care centre. The third was a locally employed dermatologist. At the actual 1998 workload of 375 patients, the total cost of teledermatology was NKr470,780, while the three alternatives cost NKr880,530, NKr1,635,075 and NKr958,660, respectively. Analysis of the unit costs showed that the realtime teledermatology service, including local phototherapy, was less costly than the three alternatives for annual workloads above 195 patients per year. A sensitivity analysis showed that the results were robust to changes in the assumptions about the cost structure.

[Will the use of still image electronic referrals save costs?]. / Vil bruk av stillbildehenvisninger vaere kostnadsbesparende?

BACKGROUND: The use of still images in an electronic referral makes it possible for patients with uncomplicated skin disorders to receive treatment at their local health clinic by their own physician. The aim of this study was to analyse whether investing in technology to forward still images via telemedicine is cost-effective and to assess how many municipalities in the counties of Troms and Finnmark that have a sufficient workload to reach this requirement. MATERIAL AND METHODS: The additional costs of using still images were compared to patient travel costs to the University Hospital of Tromsø. RESULTS: The results showed that whether the use of still image telemedicine is cost-effective or not, depends on distance and annual workload. Given the assumption in this study, 18 out of 44 municipalities have a sufficient number of patients with a dermatological problem to make telemedicine cost-effective. INTERPRETATION: Less than half of the municipalities in the two northernmost counties have an efficiency potential in using still images. However, telemedicine may be justified because it save time for patients and it increases equal access to care.

An economic analysis of teleconsultation in otorhinolaryngology.

A cost comparison of three different methods of providing consultations for ear, nose and throat (ENT) problems was carried out. The study was based on the delivery of ENT examination and treatment to a small primary-care centre without an ENT specialist in northern Norway. The three alternatives evaluated were teleconsultation, a visiting specialist and patient travel to the nearest secondary-care centre. Patient travel was cheaper for patient workloads below 56 per year. For patient workloads above 56 and below 325 patients per year teleconsultation was the cheapest alternative. Above 325 patients per year, the visiting specialist service cost less than either teleconsultation or patient travel. Transfer of medical skills from the specialist to the general practitioner was also accounted for, separately from the main cost calculation. Teleconsultation then became cost-effective for patient workloads above 52 patients per year.

An economic analysis of teleradiology versus a visiting radiologist service.

An economic analysis of the teleradiology service provided by a university hospital to a local hospital without radiologists was carried out. The average workload at the local hospital was 6000 patients (8000 examinations) per year. In these circumstances teleradiology cost NKr108 per patient, in comparison with NKr178 per patient for the visiting radiologist service which had previously been provided. The total cost of the teleradiology service amounted to NKr646,900 per year; in comparison the visiting radiologist service cost NKr1,069,000 per year. Calculations showed that for teleradiology to be cheaper, the workload had to exceed 1576 patients per year. A sensitivity analysis showed that assuming a shorter equipment lifetime, for instance four years rather than six years, made the threshold value 2320 patients per year instead of 1576.