Cost-minimization analysis of teledermatology versus conventional care in the Brazilian National Health System
Publication: Journal of Comparative Effectiveness Research
Abstract
Aims: Cost-minimization analysis (CMA) comparing the teledermatology service of the State of Santa Catarina, Brazil with the provision of conventional care, from the societal perspective. Patients & methods: All costs related to direct patient care were considered in calculation of outpatient costs. The evaluation was performed using the parameters avoided referrals and profile of hospitalizations. The economic analysis was developed through a decision tree. Results: Totally, 40% of 79,411 tests performed could be managed in primary care, avoiding commuting and expanding the patients’ access. The CMA showed the teledermatology service had a cost per patient of US$196.04, and the conventional care of US$245.66. Conclusion: In this scenario, teledermatology proved to be a cost-saving alternative to conventional care, reducing commuting costs.
Lay abstract
Diagnosis and treatment of skin diseases through teledermatology avoid patient referrals, improves accessibility to specialized care, as well as the skin care provided by physicians. This study compared the costs of the teledermatology service of the State of Santa Catarina, Brazil with the costs of the provision of conventional care, to check which of them was more efficient. All costs related to direct patient care were considered in the calculation of costs. Totally, 40% of 79,411 dermatological tests performed could be locally managed in primary care, avoiding commuting, and expanding the patients’ access to care. The teledermatology service had a cost per patient of US$196.04, compared with the cost of conventional care of US$245.66. In this evaluation, teledermatology proved to be cheaper than conventional care, reducing commuting costs.
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References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Campagna M, Naka F, Lu J. Teledermatology: an updated overview of clinical applications and reimbursement policies. Int. J. Womens Dermatol. 3(3), 176–179 (2017).
2.
Bashshur RL, Shannon GW, Tejasvi T, Kvedar JC, Gates M. The empirical foundations of teledermatology: a review of the research evidence. Telemed. J. E Health 21(12), 953–979 (2015).
3.
Eminović N, Dijkgraaf MG, Berghout RM, Prins AH, Bindels PJE, Keizer NF. A cost-minimization analysis in teledermatology: model-based approach. BMC Health Serv. Res. 10, 251 (2010).
•• A cost-minimization study design (a model-based approach) was applied to compare teledermatology and conventional process costs per dermatology patient care episode, from the societal perspective. The results showed that savings by teledermatology can be achieved if the distance to a dermatologist is larger (≥75 km) or when more consultations (≥37%) can be prevented due to teledermatology.
4.
Datta SK, Warshaw EM, Edison KE et al. Cost and utility analysis of a store-and-forward teledermatology referral system: a randomized clinical trial. JAMA Dermatol. 151(12), 1323–1329 (2015).
5.
Yarak S, Ruiz EES, Pisa IT. Teledermatology in medical practice. Rev. Bras. Educ. Med. 41(2), 346–355 (2017).
6.
Delgoshaei B, Mobinizadeh M, Mojdekar R, Afzal E, Arabloo J, Mohamadi E. Telemedicine: a systematic review of economic evaluations. Med. J. Islam. Repub. Iran. 31, 113 (2017).
7.
Wang RH, Barbieri JS, Nguyen HP et al. Clinical effectiveness and cost-effectiveness of teledermatology: where are we now, and what are the barriers to adoption? J. Am. Acad. Dermatol. 83(1), 299–307 (2020).
•• Updated paper reviews the evidence on the clinical and cost–effectiveness of teledermatology and discusses system-level and practice-level barriers to successful teledermatology implementation.
8.
Maeyama MA, Calvo MCM. Integration of telehealth in regulation centrals: the teleconsulting as a mediator between primary care and specialized care. Rev. Bras. Educ. Med. 42(2), 63–72 (2018).
9.
von Wangenheim A, Nunes DH. Creating a web infrastructure for the support of clinical protocols and clinical management: an example in teledermatology. Telemed. J. E Health 25(9), 781–790 (2019).
10.
Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews. Int. J. Med. Inform. 79(11), 736–771 (2010).
11.
Pak H, Triplett CA, Lindquist JH, Grambow SC, Whited JD. Store-and-forward teledermatology results in similar clinical outcomes to conventional clinic-based care. J. Telemed. Telecare. 13(1), 26–30 (2007).
12.
Levin YS, Warshaw EM. Teledermatology: a review of reliability and accuracy of diagnosis and management. Dermatol. Clin. 27(2), 163–176 (2009).
13.
Whited JD, Warshaw EM, Kapur K et al. Clinical course outcomes for store and forward teledermatology versus conventional consultation: a randomized trial. J. Telemed. Telecare. 19(4), 197–204 (2013).
14.
Piccoli MF, Amorim BDB, Wagner HM, Nunes DH. Teledermatology protocol for screening of skin cancer. An. Bras. Dermatol. 90(2), 202–210 (2015).
15.
Ferreira I, Godoi D, Perugini E, Lancini AB, Zonta R. Teledermatology: an interface among primary and specialized care in Florianopolis. Rev. Bras. Med. Fam. Comunidade 14(41), 2003 (2019).
16.
Vidal Alaball J, Álamo Junquera D, López-Aguilá S, Garcia-Altés A. Evaluation of the impact of teledermatology in decreasing the waiting list in the Bages region (2009–2012). Aten. Primaria. 47(5), 320–321 (2015).
17.
Raugi GJ, Nelson W, Miethke M et al. Teledermatology Implementation in a VHA secondary treatment facility improves access to face-to-face care. Telemed. J. E Health 22(1), 12–17 (2016).
18.
Whited JD. Teledermatology. Med. Clin. North Am. 99(6), 1365–1379 (2015).
• An overview of teledermatology with an emphasis on the evidence most relevant to referring clinicians. The paper discusses the different modalities used for teledermatology and their diagnostic reliability, diagnostic accuracy, impact on in-person dermatology visits, clinical outcomes and user satisfaction.
19.
Giavina-Bianchi M, Santos AP, Cordioli E. Teledermatology reduces dermatology referrals and improves access to specialists. EClinicalMedicine. 29–30, 100641 (2020).
20.
Wootton R, Bahaadinbeigy K, Hailey D. Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: proposal for quantitative synthesis in a systematic review. BMC Health. Serv. Res. 11, 185 (2011).
21.
McFarland LV, Raugi GJ, Taylor LL, Reiber GE. Implementation of an education and skills programme in a teledermatology project for rural veterans. J. Telemed. Telecare. 18(2), 66–71 (2012).
22.
Mohan G, Molina GE, Stavert R. Store and forward teledermatology improves dermatology knowledge among referring primary care providers: a survey-based cohort study. J. Am. Acad. Dermatol. 79(5), 960–961 (2018).
23.
Sharma P, Kovarik CL, Lipoff JB. Teledermatology as a means to improve access to inpatient dermatology care. J. Telemed. Telecare. 22(5), 304–310 (2016).
24.
Barbieri JS, Nelson CA, James WD et al. The reliability of teledermatology to triage inpatient dermatology consultations. JAMA Dermatol. 150(4), 419–424 (2014).
25.
Jariwala NN, Snider CK, Mehta SJ et al. Prospective implementation of a consultative store-and-forward teledermatology model at a single urban academic health system with real cost data subanalysis. Telemed. J. E Health. (2020). (Epub ahead of print).
26.
Zakaria A, Miclau TA, Maurer T, Leslie KS, Amerson E. Cost minimization analysis of a teledermatology triage system in a managed care setting. JAMA Dermatol. 157(1), 52–58 (2021).
•• A retrospective cost minimization analysis comparing the organization-wide cost of managing referred patients within a teledermatology triage system versus a conventional dermatology care model. Managed healthcare settings may experience significant cost savings from using teledermatology to triage and manage patients.
27.
Maddukuri S, Patel J, Lipoff JB. Teledermatology addressing disparities in health care access: a review. Curr. Derm. Rep. 10, 40–47 (2021).
28.
Tensen E, van der Heijden JP, Jaspers MW, Witkamp L. Two decades of teledermatology: current status and integration in national healthcare systems. Curr. Dermatol. Rep. 5, 96–104 (2016).
29.
Snoswell C, Finnane A, Janda M, Soyer HP, A Whitty JA. Cost–effectiveness of store-and-forward teledermatology: a systematic review. JAMA Dermatol 152(6), 702–708 (2016).
•• Summarizes and evaluates the current economic evidence comparing store-and-forward teledermatology with conventional face-to-face care. Teledermatology appears to be cost-effective when used as a triage mechanism to reduce face-to-face appointment requirements. Its cost–effectiveness increases when patients are required to travel farther distances to access dermatology services.
30.
Vidal-Alaball J, Garcia Domingo JL, Garcia Cuyàs F et al. A cost savings analysis of asynchronous teledermatology compared to face-to-face dermatology in Catalonia. BMC Health Serv. Res. 18, 650 (2018).
31.
Pak HS, Datta SK, Triplett CA, Lindquist JH, Grambow SC, Whited JD. Cost minimization analysis of a store-and-forward teledermatology consult system. Telemed. J. E Health. 15(2), 160–165 (2009).
32.
Landow SM, Mateus A, Korgavkar K et al. Teledermatology: Key factors associated with reducing face-to-face dermatology visits. J. Am. Acad. Dermatol. 71(3), 570–576 (2014).
• Highlights factors that are associated with a higher number of face-to-face appointments avoided by teledermatology programs: effective preselection of patients for teleconsultation, high-quality photographic images, dermoscopy if pigmented lesions are evaluated and effective infrastructure and culture in place to implement teleconsultation recommendations.
33.
Livingstone J, Solomon J. An assessment of the cost–effectiveness, safety of referral and patient satisfaction of a general practice teledermatology service. London J. Prim. Care. 7(2), 31–35 (2015).
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Published In
Pages: 1159 - 1168
PubMed: 34494888
Copyright
© 2021 Future Medicine Ltd.
History
Received: 27 May 2021
Accepted: 4 August 2021
Published online: 8 September 2021
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Funding Information
Institutional Development Program of the Brazilian National Health System (PROADI-SUS), Hospital Alemão Oswaldo Cruz: NUP: 25000.018744/2018-49
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Cost-minimization analysis of teledermatology versus conventional care in the Brazilian National Health System. (2021) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2021-0124
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Citing Literature
- Camila Acordi da Silva, Andressa Konrad Corcetti, Franciele Cascaes da Silva, Oscar Cardoso Dimatos, DISTRIBUIÇÃO DOS DERMATOLOGISTAS NO ESTADO DE SANTA CATARINA, Arquivos Catarinenses de Medicina, 10.63845/dhk35997, 54, 4, (115-127), (2026).
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- Kevin Yun Kim, Lung Wen Chao, Cyro Festa Neto, História da Teledermatologia e sua evolução, aspectos práticos e perspectivas futuras no Brasil, Anais Brasileiros de Dermatologia (Versão em Português), 10.1016/j.abdp.2025.501208, 100, 6, (501208), (2025).
- Kevin Yun Kim, Lung Wen Chao, Cyro Festa Neto, The history of Teledermatology and its evolution, practical aspects, and prospects in Brazil, Anais Brasileiros de Dermatologia, 10.1016/j.abd.2025.501208, 100, 6, (501208), (2025).
- Sei-Jong Baek, Jeong-Ah Choi, Jin-Won Noh, Hyoung-Sun Jeong, A Cost-Minimization Analysis of Teleconsultation Versus In-Person Care for Chronic Diseases and Rehabilitation in Medically Underserved Areas of South Korea, Healthcare, 10.3390/healthcare13050445, 13, 5, (445), (2025).
- Sonya Ahuja, Shanelle Mariah Briggs, Sigrid Marie Collier, Teledermatology in Rural, Underserved, and Isolated Environments: A Review, Current Dermatology Reports, 10.1007/s13671-022-00377-2, 11, 4, (328-335), (2022).
- Petre Ilie, Simina Stefanescu, Jane Aldridge, Philip Gaffney, James Belcher, Lee Smith, Value of DermaCheckup as a novel dedicated digital health solution for teledermatology, Medicine International, 10.3892/mi.2022.30, 2, 1, (2022).
