Economic evaluation of a general practitioner with special interests led dermatology service in primary care.
OBJECTIVE
To carry out an economic evaluation of a general practitioner with special interest service for non-urgent skin problems compared with hospital outpatient care.


METHODS
Cost effectiveness analysis and cost consequences analysis alongside a randomised controlled trial.


METHODS
General practitioner with special interest dermatology service covering 29 general practices in Bristol.


METHODS
Adults referred to a hospital dermatology clinic who were potentially suitable for management by a general practitioner with special interest.


METHODS
Participants were randomised 2:1 to receive either care by general practitioner with special interest service or usual hospital outpatient care.


METHODS
Costs to NHS, patients, and companions, and costs of lost production. Cost effectiveness, using the two primary outcomes of dermatology life quality index scores and improved patient perceived access, was assessed by incremental cost effectiveness ratios and cost effectiveness acceptability curves. Cost consequences are presented in relation to all costs and both primary and secondary outcomes from the trial.


RESULTS
Costs to the NHS for patients attending the general practitioner with special interest service were 208 pounds sterling (361 dollars; 308 euro) compared with 118 pounds sterling for hospital outpatient care. Based on analysis with imputation of missing data, costs to patients and companions were 48 pounds sterling and 51 pounds sterling, respectively; costs of lost production were 27 pounds sterling and 34 pounds sterling, respectively. The incremental cost effectiveness ratios for general practitioner with special interest care over outpatient care were 540 pounds sterling per one point gain in the dermatology life quality index and 66 pounds sterling per 10 point change in the access scale.


CONCLUSIONS
The general practitioner with special interest service for dermatology is more costly than hospital outpatient care, but this additional cost needs to be weighed against improved access and broadly similar health outcomes.
Coast
Joanna
J
Department of Social Medicine, University of Bristol, Bristol BS8 2PR. j.coast@bham.ac.uk
Noble
Sian
S
Noble
Alison
A
Horrocks
Sue
S
Asim
Oya
O
Peters
Tim J
TJ
Salisbury
Chris
C
D000553:Ambulatory Care / Q000191:economics*; D003362:Cost-Benefit Analysis; D004739:England; D005194:Family Practice / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D017060:Patient Satisfaction; D019057:Quality-Adjusted Life Years; D012017:Referral and Consultation; D012871:Skin Diseases / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome