A cost minimisation analysis in teledermatology: model-based approach.

BACKGROUND: Although store-and-forward teledermatology is increasingly becoming popular, evidence on its effects on efficiency and costs is lacking. The aim of this study, performed in addition to a clustered randomised trial, was to investigate to what extent and under which conditions store-and-forward teledermatology can reduce costs from a societal perspective. METHODS: A cost minimisation study design (a model based approach) was applied to compare teledermatology and conventional process costs per dermatology patient care episode. Regarding the societal perspective, total mean costs of investment, general practitioner, dermatologists, out-of-pocket expenses and employer costs were calculated. Uncertainty analysis was performed using Monte Carlo simulation with 31 distributions in the used cost model. Scenario analysis was performed using one-way and two-way sensitivity analyses with the following variables: the patient travel distance to physician and dermatologist, the duration of teleconsultation activities, and the proportion of preventable consultations. RESULTS: Total mean costs of teledermatology process were €387 (95%CI, 281 to 502.5), while the total mean costs of conventional process costs were €354.0 (95%CI, 228.0 to 484.0). The total mean difference between the processes was €32.5 (95%CI, -29.0 to 74.7). Savings by teledermatology can be achieved if the distance to a dermatologist is larger (> = 75 km) or when more consultations (> = 37%) can be prevented due to teledermatology. CONCLUSIONS: Teledermatology, when applied to all dermatology referrals, has a probability of 0.11 of being cost saving to society.In order to achieve cost savings by teledermatology, teledermatology should be applied in only those cases with a reasonable probability that a live consultation can be prevented. TRIAL REGISTRATION: This study is performed partially based on PERFECT D Trial (Current Controlled Trials No. ISRCTN57478950).

Evaluation of general practitioner's time investment during a store-and-forward teledermatology consultation.

BACKGROUND/OBJECTIVE: Introduction of teledermatology in general practice changes responsibilities and workloads of general practitioners (GPs) and dermatologists. We investigated the time investment of GPs as well as the relative share of the separate teledermatology activities during a store-and-forward teledermatology consultation. METHODS: Sixty-four teledermatology consultations (eight GPs x eight patients) were conducted in a laboratory setting. The starting and ending time of each consultation and of five separate teledermatology activities were recorded by independent observers. The impact of several GP, patient and consultation characteristics on the calculated durations was investigated with repeated measurements analysis. RESULTS: The mean duration of a teledermatology consultation was 11:32 min (range 7:02-26:44 min). The activity 'filling out electronic referral form' was the most time consuming teledermatology activity (3:12 min; 28%). Most time was spent on non-TD related consultation activities, e.g. taking medical history (4:43 min; 41%). The first of the eight consultations (p<0.001) and consultations with female patients (p=0.032) took on average more time than subsequent consultations (first consultations 13:42 min (male patients) and 17:03 min (female patients), and subsequent consultations 9:56 min (male patients) and 11:08 min (female patients)). CONCLUSIONS: Usage of store-and-forward teledermatology increases the average duration of a GP consultation with at least three and a half minutes. Further integration of teledermatology applications and electronic patients' records may reduce the total duration of a consultation and increase acceptance of teledermatology in general practice.