Multicentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care: societal cost-benefit analysis

British Medical Journal, May 6, 2000 by R Wootton, S E Bloomer, R Corbett, D J Eedy, N Hicks, H E Lotery, C Mathews, J Paisley, K Steele, M A Loane

                                          Telemedicine (n=102)

                                           Recorded   Actual

Once only visit                            22 (22)    42 (41)
General practice follow up                 33 (32)    18 (18)
Hospital follow up                         47 (46)    34 (33)
General practice and hospital follow up       0        8 (8)
Did not attend                                0          0

                                          Conventional (n=102)

                                           Recorded   Actual

Once only visit                            40 (39)    50 (49)
General practice follow up                 15 (15)    10 (10)
Hospital follow up                         46 (45)    33 (32)
General practice and hospital follow up       0        8 (8)
Did not attend                              1 (1)      1 (1)

Patients seen by teledermatology made fewer return visits to their general practitioner and hospital compared with patients seen conventionally. The mean number of additional visits to primary and secondary care made by the telemedicine group was 1.63 (SD 0.78, 95% confidence interval 1.43 to 1.83, range 1-4) compared with 2.12 (SD 1.93, 95% confidence interval 1.62 to 2.62, range 1-10) by the conventional group.

Costs

Of the 204 patients in the study, 83 attended a further hospital appointment; thus the maximum possible return rate for the patient economic questionnaire was 287. A total of 169 questionnaires were returned, giving a response rate of 59%. In all, 62% (63/102) of patients randomised to teledermatology completed the questionnaire compared with 57% 9106/185) of those randomised to a conventional appointment. Table 2 shows the average patient time involved for each group.

Table 2 Patient time (minute) involved in initial dermatology appointments

                           Telemedicine

                No of        Mean
Time           patients    (SD) time       95% CI

Travel(*)         55      31.2 (20.4)   25.8 to 36.6
Waiting           56       5.3 (7.2)     3.4 to 7.2
Consultation      88      15.7 (4.6)    14.7 to 16.7
Total                     52.2 (32.2)   43.9 to 60.5

                           Conventional

                No of        Mean
Time           patients    (SD) time       95% CI

Travel(*)         95      48.8 (297)    42.9 to 54.7
Waiting           96      20.3 (14.1)   17.5 to 23.1
Consultation      52      13.9 (7.0)    12.0 to 15.8
Total                     83.0 (50.3)   72.4 to 93.6

(*) To and from appointment.

The hourly rate of a consultant dermatologist including overhead costs was estimated to be 150.00 [pounds sterling] and the hourly rate of a general practitioner 114.00 [pounds sterling] (MedEconomics). The average cost of consultant time was 39.25 [pounds sterling] for a teledermatology consultation and 34.75 [pounds sterling] for a conventional consultation. The average cost of general practitioner time at a teledermatology consultation was 29.83 [pounds sterling].

The cost of patient time was calculated by taking the average annual income as recorded by the 130 patients who completed this section of the economic questionnaire (12 115.38 [pounds sterling]) divided by 220 working days, divided by eight working hours, divided by 60 minutes, multiplied by total patient time (table 2). Patient costs were thus 5.99 [pounds sterling] for teledermatology and 9.52 [pounds sterling] for conventional consultation.