title: [An economic analysis of presurgical teledermatology in patients with nonmelanoma skin cancer].
abstract: BACKGROUND
  In patients with nonmelanoma skin cancer, store-and-forward teledermatology allows satisfactory diagnosis and surgical planning, thus shortening waiting lists and reducing travel requirements for patients in special situations.
  
  
  OBJECTIVE
  The aim of this study was to undertake an economic analysis of presurgical teledermatology, comparing it with a conventional health care approach.
  
  
  METHODS
  The cost and cost-effectiveness of presurgical teledermatology were analyzed from a societal perspective in the setting of a public hospital with a corporate intranet. The mean delay in surgery was used to measure effectiveness. Over a 12-month period, teledermatology was used in 134 patients with nonmelanoma skin cancer. The unit cost of each intervention (teledermatology and conventional health care approach), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated. We distinguished between 2 groups of patients: those with and those without physical impediments for travel.
  
  
  RESULTS
  The unit cost of the patients in whom teledermatology was used was euro 156.40 compared to euro 278.42 per patient in the conventional system; the conventional system was therefore 1.78 times more expensive than presurgical teledermatology. Teledermatology was more cost-effective, with an incremental cost-effectiveness ratio of euro 3.10 per patient and per day of delay avoided in patients without impediments for travel and euro 4.87 in those with impediments for travel.
  
  
  CONCLUSIONS
  Teledermatology used for remote presurgical planning and preparation in patients with nonmelanoma skin cancer is more cost-effective than the conventional referral system in a health setting with a communication network available.
authors.affiliation: Departamento de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España. lferrandiz@e-derma.org
authors.forename: L
authors.initials: L
authors.lastname: Ferrándiz
authors.forename: D
authors.initials: D
authors.lastname: Moreno-Ramírez
authors.forename: A
authors.initials: A
authors.lastname: Ruiz-de-Casas
authors.forename: A
authors.initials: A
authors.lastname: Nieto-García
authors.forename: P
authors.initials: P
authors.lastname: Moreno-Alvarez
authors.forename: R
authors.initials: R
authors.lastname: Galdeano
authors.forename: F M
authors.initials: FM
authors.lastname: Camacho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002201:Capital Expenditures / Q000706:statistics & numerical data; D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D003880:Dermatology / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000191:economics; D010781:Photography / Q000191:economics / Q000295:instrumentation; D011300:Preoperative Care / Q000191:economics* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics; D012017:Referral and Consultation / Q000191:economics; D019114:Remote Consultation / Q000191:economics* / Q000295:instrumentation / Q000706:statistics & numerical data; D012878:Skin Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013030:Spain; D013997:Time Factors