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

The cost of patient travel depended on the mode of transport used and the distance travelled (table 3). We calculated the cost of car travel using the standard car mileage allowance of 25 pence a mile (15.5 p/km, Inland Revenue). Patients attending the teledermatology consultation by car travelled a total of 570.9 km compared with 2456.6 km by those attending hospital appointments by car. Total public transport fares were 5.80 [pounds sterling] in the telemedicine group and 55.74 [pounds sterling] in the conventional group. Patients who walked had no transport costs. Thus the average travel cost incurred by patients in each group was 1.89 [pounds sterling] for teledermatology ((570.9x0.155) 5.80 = 94.49 [pounds sterling] /50) and 4.46 [pounds sterling] for conventional care ((2456.6x0.155) 55.74 = 437.37 [pounds sterling] /98).

Table 3 Method of travel to dermatology appointments and distances travelled

                        Telemedicine   Conventional
                           (n=58)        (n=101)

Method of travel
  Car                     48 (83)        83 (82)
  Public transport         2 (3)         15 (15)
  Walk                     8 (14)         3 (3)
Travel distance (km):
  Mean (SD)              10.3 (9.1)    26.0 (23.2)
  Range                 0.4 to 35.4    0.8 to 80.5
  95% CI                8.0 to 12.6    21.4 to 30.6

Table 4 shows the cost of all the telemedicine equipment used in the trial (1995 prices) and the telecommunications charges relating to the trial.

Table 4 Costs of equipment and telecommunication (to nearest [pounds sterling])

                                      Equipment

                  Videoconferencing
                        unit         Camera   Connection   Total

Health centre 1        5 999         2 000        199       8 198
Health centre 2        5 999         2 000        199       8 198
Health centre 3        5 999         3 732        400      10 131
Health centre 4        5 999         3 732        400      10 131
Hospital 1             5 999           0          400       6 399
Hospital 2             5 999           0          400       6 399
Total                 35 994         11 464      1998      49 456

                    Telecommunications

                            Call
                  Rental   costs   Total

Health centre 1     535      12      547
Health centre 2     535      12      547
Health centre 3     352      80      432
Health centre 4     352     112      464
Hospital 1          352      16      368
Hospital 2          352       0      352
Total              2478     231     2709

Benefits

As a result of the learning benefits and increased confidence in managing patients obtained from the joint videolink consultations, general practitioners estimated that dermatology referrals could be reduced by an average of 20% (range 10-25%) with concurrent savings of consultant time, patient time, and patient travel costs. Interview data from one of the health centres was not included in the analysis as a locum was employed to cover the teledermatology sessions and the benefits for a locum may differ from those for a practice member. The general practitioners estimated that it would require an average of 6.3 days of training (range 4.0-7.5) to gain the same experience obtained from being present at the teledermatology consultations. With the average cost of a general practitioner training course at 60.00 [pounds sterling] per day (Northern Ireland Postgraduate Council) and the cost of a general practitioner at 114.00 [pounds sterling] an hour, the cost of equivalent training would be 6123.60 [pounds sterling] per general practitioner. Table 5 shows the total calculated costs and benefits pertaining to the trial. The net cost (to society) of the initial teledermatology consultation was 132.10 [pounds sterling] (SD 24.63 [pounds sterling]) a patient compared with 48.73 [pounds sterling] (18.4 [pounds sterling]) a patient for the initial conventional outpatient consultation.