title: Diagnostic accuracy and cost-effectiveness of dermoscopy in primary care: a cluster randomized clinical trial.
abstract: OBJECTIVE
  To determine the DA and cost-effectiveness of the dermoscope in primary care for skin lesions suspected of malignancy.
  
  
  METHODS
  In a cluster randomized clinical trial, 48 Dutch general practices were randomized to either intervention group using a dermoscope or control group using only naked-eye examination. A total of 194 lesions from 170 patients in the intervention group and 222 lesions from 211 patients in the control group were analysed for DA and cost-effectiveness.
  
  
  RESULTS
  The percentage of correctly diagnosed lesions in intervention group and control group was 50.5% and 40.5% respectively. This was 61.5% and 22.2% for melanomas. In the intervention group, three malignancies were treated with the expectative treatment option compared to none in the control group. The odds ratio (OR) of a correct diagnosis in the intervention group, compared to control group, was 1.51 (95% CI: 0.96–2.37) P = 0.07. Consequently, the relative risk was 1.25. The incremental cost-effectiveness ratio was €89 (95% CI −€60 to €598), indicating that using a dermoscope costs an additional €89 for one additional correctly diagnosed patient. Additional analyses showed better effects of dermoscopy compared to the control group for 98% of the bootstrap resamples.
  
  
  CONCLUSIONS
  The probability of a correct diagnosis was 1.25 times higher using a dermoscope than without a dermoscope. Although this difference is marginally not statistically significant, dermoscopy in general practice appears to be cost effective. We therefore think that GPs should be trained to use a dermoscope, although they should realize that even with the use of a dermoscope not all lesions will be diagnosed correctly.
authors.forename: C J L
authors.initials: CJ
authors.lastname: Koelink
authors.forename: K M
authors.initials: KM
authors.lastname: Vermeulen
authors.forename: B J
authors.initials: BJ
authors.lastname: Kollen
authors.forename: G H
authors.initials: GH
authors.lastname: de Bock
authors.forename: J H
authors.initials: JH
authors.lastname: Dekker
authors.forename: M F
authors.initials: MF
authors.lastname: Jonkman
authors.forename: W K
authors.initials: WK
authors.lastname: van der Heide
mesh_terms: D000328:Adult; D000368:Aged; D002280:Basal Cell Carcinoma / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D046169:Dermoscopy / Q000191:economics*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D012871:Skin Diseases / Q000175:diagnosis* / Q000473:pathology; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology