An economic evaluation of the Highlands and Islands teledentistry project.
A 12-month trial of teledentistry was conducted in two general dental practices (one in the Orkney Islands and one in the Scottish Highlands at Kingussie). The dental practices had a PC-based videoconferencing link, connected by ISDN at 128 kbit/s, to a restorative specialist at a hospital in Aberdeen. Twenty-five patients were recruited into the trial. A cost-minimization analysis was undertaken by comparing the costs of teledentistry with two alternatives: outreach visits, where the specialist regularly visited the remote communities, and hospital visits, where patients in remote communities travelled to hospital for consultation. For Orkney patients, dental teleconsultations cost the National Health Service (NHS) an additional  36 per patient compared with outreach visits, but cost-savings of  270 per patient could be achieved compared with hospital visits. For Kingussie patients, teleconsultations cost the NHS an additional  44 and there were cost-savings of  1.54 compared with outreach visits and hospitals visits, respectively. However, patients incurred additional costs for radiographs and photographs, and the general dental practitioner incurred additional preparation time costs. When the value of patient time was included, there were cost-savings of around  900 per Orkney patient compared with hospital visits, but compared with outreach visits teledentistry cost an additional  180 per patient. Based on the trial data, there were no cost-savings from teledentistry for Kingussie patients, even when the value of time was included. These results were relatively robust in a sensitivity analysis. However, we estimated that the cost-effectiveness of teledentistry would improve with greater familiarity and use of equipment. Benefits and cost-savings would be greatest in island or remote communities, where patients have to travel long distances to hospital for specialist consultations.
Scuffham
P A
PA
York Health Economics Consortium, University of York, UK. pas8@york.ac.uk
Steed
M
M
D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis / Q000191:economics; D003729:Dental Care / Q000191:economics* / Q000379:methods; D006801:Humans; D008875:Middle Aged; D019114:Remote Consultation / Q000191:economics* / Q000379:methods; D019035:Rural Health Services / Q000191:economics* / Q000458:organization & administration; D012606:Scotland; D013222:State Medicine / Q000191:economics