Multicentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care: societal cost-benefit analysis.
OBJECTIVE
Comparison of real time teledermatology with outpatient dermatology in terms of clinical outcomes, cost-benefits, and patient reattendance.


METHODS
Randomised controlled trial with a minimum follow up of three months.


METHODS
Four health centres (two urban, two rural) and two regional hospitals.


METHODS
204 general practice patients requiring referral to dermatology services; 102 were randomised to teledermatology consultation and 102 to traditional outpatient consultation.


METHODS
Reported clinical outcome of initial consultation, primary care and outpatient reattendance data, and cost-benefit analysis of both methods of delivering care.


RESULTS
No major differences were found in the reported clinical outcomes of teledermatology and conventional dermatology. Of patients randomised to teledermatology, 55 (54%) were managed within primary care and 47 (46%) required at least one hospital appointment. Of patients randomised to the conventional hospital outpatient consultation, 46 (45%) required at least one further hospital appointment, 15 (15%) required general practice review, and 40 (39%) no follow up visits. Clinical records showed that 42 (41%) patients seen by teledermatology attended subsequent hospital appointments compared with 41 (40%) patients seen conventionally. The net societal cost of the initial consultation was pound132.10 per patient for teledermatology and pound48.73 for conventional consultation. Sensitivity analysis revealed that if each health centre had allocated one morning session a week to teledermatology and the average round trip to hospital had been 78 km instead of 26 km, the costs of the two methods of care would have been equal.


CONCLUSIONS
Real time teledermatology was clinically feasible but not cost effective compared with conventional dermatological outpatient care. However, if the equipment were purchased at current prices and the travelling distances greater, teledermatology would be a cost effective alternative to conventional care.
Wootton
R
R
Institute of Telemedicine and Telecare, Royal Hospitals Trust, Belfast BT12 6BA. r.wootton@pobox.com
Bloomer
S E
SE
Corbett
R
R
Eedy
D J
DJ
Hicks
N
N
Lotery
H E
HE
Mathews
C
C
Paisley
J
J
Steele
K
K
Loane
M A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D012424:Rural Population; D012871:Skin Diseases / Q000175:diagnosis* / Q000628:therapy; D017216:Telemedicine / Q000191:economics / Q000592:standards*; D014195:Travel; D016896:Treatment Outcome; D014505:Urban Population