What is the least costly strategy to evaluate cervical abnormalities in rural women? Comparing telemedicine, local practitioners, and expert physicians.
OBJECTIVE
This study establishes the least costly strategy for evaluation of rural women in need of colposcopy among 3 alternatives: telemedicine, local practitioners, and referral experts.


METHODS
Women in rural Georgia who needed colposcopy were examined by an expert colposcopist on site, by a local practitioner, and by a distant expert colposcopist linked by telemedicine. Independent determinations of biopsy intent were used to model the differing biopsy costs of the 3 methods. Record review determined the average total cost of telemedicine. Reports of average cost in year 2000 dollars from societal perspective include medical costs and pain and suffering due to additional biopsies and curettage, telemedicine costs, and costs of potential diagnostic delay for a 1-year time horizon.


RESULTS
From the societal perspective in the baseline case, the average cost per patient evaluated was dollar 270 for patients seen by referral experts. The cost was dollar 38 less (e.g., dollar 232) for patients seen by local practitioners, and dollar 35 more (e.g., dollar 305) for patients seen by telemedicine. From the societal perspective, local practitioners were less costly than referral experts because of lower travel costs for patients, but from the medical perspective, their average cost was dollar 32 higher than referral experts because they performed more biopsies and curettage procedures than experts. Telemedicine assistance would have lowered the number of biopsies performed by local practitioners, but as of year 2000 the costs of this technology could not be justified by the savings.


CONCLUSIONS
From the societal perspective, local practitioners performing colposcopy are the least costly way to evaluate cervical abnormalities in rural patients with substantial time and travel costs.
Bishai
David M
DM
Department of Population and Family Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205, USA. dbishai@jhu.edu
Ferris
Daron G
DG
Litaker
Mark S
MS
D003127:Colposcopy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005845:Georgia; D017048:Health Care Costs; D006297:Health Services Accessibility; D006801:Humans; D009722:Nurse Practitioners / Q000191:economics; D012017:Referral and Consultation / Q000191:economics*; D019035:Rural Health Services / Q000191:economics*; D012424:Rural Population; D017216:Telemedicine / Q000191:economics* / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000601:surgery; D014626:Vaginal Smears / Q000191:economics*