[An economic analysis of presurgical teledermatology in patients with nonmelanoma skin cancer]. / Teledermatología prequirúrgica en pacientes con cáncer cutáneo no melanoma. Evaluación económica.

INTRODUCTION: In patients with nonmelanoma skin cancer, store-and-forward teledermatology allows satisfactory diagnosis and surgical planning, thus shortening waiting lists and reducing travel requirements for patients in special situations. OBJECTIVE: The aim of this study was to undertake an economic analysis of presurgical teledermatology, comparing it with a conventional health care approach. MATERIAL AND METHODS: The cost and cost-effectiveness of presurgical teledermatology were analyzed from a societal perspective in the setting of a public hospital with a corporate intranet. The mean delay in surgery was used to measure effectiveness. Over a 12-month period, teledermatology was used in 134 patients with nonmelanoma skin cancer. The unit cost of each intervention (teledermatology and conventional health care approach), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated. We distinguished between 2 groups of patients: those with and those without physical impediments for travel. RESULTS: The unit cost of the patients in whom teledermatology was used was euro 156.40 compared to euro 278.42 per patient in the conventional system; the conventional system was therefore 1.78 times more expensive than presurgical teledermatology. Teledermatology was more cost-effective, with an incremental cost-effectiveness ratio of euro 3.10 per patient and per day of delay avoided in patients without impediments for travel and euro 4.87 in those with impediments for travel. CONCLUSION: Teledermatology used for remote presurgical planning and preparation in patients with nonmelanoma skin cancer is more cost-effective than the conventional referral system in a health setting with a communication network available.

Teledermatología prequirúrgica en pacientes con cáncer cutáneo no melanoma. Evaluación económica / An economic analysis of presurgical teledermatology in patients with nomelanoma skin cancer

Introducción. En pacientes con cáncer de piel no melanoma la teledermatología diferida permite una adecuada aproximación diagnóstica y planificación quirúrgica, acortando la demora y evitando desplazamientos en pacientes con situaciones especiales. Objetivo. Evaluación económica de la teledermatología prequirúrgica, comparándola con la asistencia convencional. Material y método. Descripción de costes y análisis coste-efectividad bajo una perspectiva social de la teledermatología prequirúrgica en el ámbito de un hospital público dotado de infraestructura de redes (intranet corporativa). Se consideró como medida de efectividad la demora media hasta la intervención quirúrgica. Durante un período de 12 meses se atendieron un total de 134 pacientes con cáncer no melanoma mediante teledermatología, calculando el coste unitario de cada intervención (teledermatología y asistencia convencional), la ratio de coste entre la alternativa más cara y la más barata y la ratio de coste-efectividad incremental. Se diferenciaron dos grupos de pacientes, con y sin dificultades físicas para el desplazamiento. Resultados. El coste unitario de los pacientes atendidos mediante teledermatología fue de 156,40 euros, frente a 278,42 euros por paciente en el sistema convencional; la asistencia convencional resultó 1,78 veces más cara que la teledermatología prequirúrgica. La teledermatología demostró ser más coste-efectiva, con una ratio coste-efectividad incremental de 3,10 euros ahorrados por paciente y día de demora evitado en pacientes sin dificultades para el desplazamiento, y de 4,87 euros en pacientes con dificultades para el desplazamiento. Conclusión. La teledermatología orientada a la planificación y preparación prequirúrgica remota de pacientes con cáncer no melanoma es una intervención más coste-efectiva que el sistema de derivación convencional en un medio sanitario dotado de infraestructura de redes de comunicación (AU)

Introduction. In patients with non melanoma skin cancer, store-and-forward teledermatology allows satisfactory diagnosis and surgical planning, thus shortening waiting lists and reducing travel requirements for patients in special situations. Objective. The aim of this study was to undertake an economic analysis of presurgical teledermatology, comparing it with a conventional health care approach. Material and methods. The cost and cost-effectiveness of presurgical teledermatology were analyzed from a societal perspective in the setting of a public hospital with a corporate intranet. The mean delay in surgery was used to measure effectiveness. Over a 12-month period, teledermatology was used in 134 patients with non melanoma skin cancer. The unit cost of each intervention (teledermatology and conventional health care approach), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated. We distinguished between 2 groups of patients: those with and those without physical impediments for travel. Results. The unit cost of the patients in whom teledermatology was used was 1156.40 compared to 1278.42 per patient in the conventional system; the conventional system was therefore 1.78 times more expensive than presurgical teledermatology. Teledermatology was more cost-effective, with an incremental cost-effectiveness ratio of 13.10 per patient and per day of delay avoided in patients without impediments for travel and 14.87 in those with impediments for travel. Conclusion. Teledermatology used for remote presurgical planning and preparation in patients with non melanoma skin cancer is more cost-effective than the conventional referral system in a health setting with a communication network available (AU)

Teledermatoscopy as a triage system for pigmented lesions: a pilot study.

BACKGROUND: Skin-cancer screening should rely on simple, low-cost and high-sensitivity diagnostic procedures. AIMS: To compare diagnosis and management options after the evaluation of clinical and dermatoscopic teleconsultations with a store-and-forward teledermatology screening system for pigmented lesions. METHODS: Kappa values between telediagnoses and the gold standard (histological examination) were assessed. Referral rates, diagnostic confidence level (DCL), sensitivity and specificity were evaluated in both approaches. Picture quality and time and cost investments were also measured. In total, 61 teleconsultations were evaluated. RESULTS: Sensitivity of the clinical and dermatoscopic teleconsultations was 1 for both, whereas specificities were 0.65 and 0.78, respectively (P < 0.05). DCL was higher for the dermatoscopic teleconsultations (4.75 vs. 4.14, P < 0.05). Agreement between the clinical and dermatoscopic teleconsultation was kappa = 0.89 (95% CI 0.81-0.97). Agreement with the gold standard was 0.91 (95% CI 0.82-1.00) for the clinical teleconsultation and 0.94 (95% CI 0.88-1.00) for teledermatoscopy (P > 0.05). Teledermatoscopy increased the economic investment of a teledermatology facility by 2.4 times. The GP spent 1.5 times longer on dermatoscopic teleconsultations. CONCLUSIONS: Teledermatoscopy has improved the DCL, specificity and referral rates of a teledermatology-based screening system for pigmented lesions. A more detailed economic analysis remains to be performed before recommending teledermatoscopy as a routine screening procedure in pigmented-lesion clinics.