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

Factors omitted from cost-benefit analysis

Physical, social and psychological impact on the patient of the skin complaint being resolved sooner rather than later

Effect of long waiting lists for a specialist appointment on patient morale and ultimately patient health

Avoidance of paying for interim treatments while waiting for specialist appointment

Greater convenience to patients of being seen at their local health centre

Less time off work

Enhanced general practitioner job satisfaction

Equipment maintenance and repair

Training staff to use equipment

Costs of return visits

What is already known on this topic

Telemedicine is to be implemented in the NHS where it is effective and appropriate

Real time teledermatology consultations are technically and clinically feasible

What this study adds

Teledermatology is more expensive than conventional consultations because of the cost of equipment and general practitioner time

It becomes more cost effective when patients have to travel greater distances to hospital

Education of general practitioners in joint consultations could reduce the number of referrals

Contributors: RW defined the research question, contributed to the conception and design of the trial, analysed the data, cowrote the paper, and is the guarantor. MAL contributed to the conception and design of the trial, coordinated the trial centres, analysed the data, and cowrote the paper. RC, DJE, KS, CM, NV, JP, SEB, and HEL contributed to the conception and design of the trial and helped write the paper.

Funding: The UK multicentre teledermatology trial was funded by the NHS research and development programme (primary and secondary interface). We also received support from Southern Health and Social Services Board (Northern Ireland), Glaxo, and Steifel. Segal Quince Wicksteed consultancy provided health economics advice.

Competing interests: None declared.

[1] House of Commons Official Report (Hansard) 1998 October 5;593 (201):cols 68-9.

[2] Royal College of General Practitioners. Morbidity statistics from general practice. Fourth national study 1991-92. London: HMSO, 1995.

[3] Department of Health. Personnel and social services statistics for England. London: HMSO, 1994.

[4] Ryan T. Dermatology-a service under threat. London: British Association of Dermatology, 1993.

[5] Oakley AMM, Astwood DR, Loane M, Duffill MB, Rademaker M, Wootton R. Diagnostic accuracy of teledermatology: results of a preliminary study in New Zealand. N Z Med J 1997;110:51-3.

[6] Gilmour E, Campbell SM, Loane MA, Esmail A, Griffiths CEM, Roland MO, et al. Comparison of teleconsultations and face-to-face consultations: preliminary results of a UK multicentre teledermatology study. Br J Dermatol 1998;139:81-7.

[7] Loane M, Corbett R, Bloomer S, Eedy D, Gore H, Mathews C, et al. Diagnostic accuracy and clinical management by real-time teledermatology: results from the Northern Ireland arms of the UK multicentre teledermatology trial. J Telemedicine Telecare 1998;4:95-100.

[8] Phillips CM, Burke WA, Shechter A, Stone D, Balch D, Gustke S. Reliability of dermatology teleconsultations with the use of teleconferencing technology. J Am Acad Dermatol 1997;37:398-402.