Cost-effectiveness of skin cancer referral and consultation using teledermoscopy in Australia

Centaine L. Snoswell, Liam J. Caffery, Jennifer A. Whitty, H. Peter Soyer, Louisa G. Gordon

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Importance: International literature has shown that teledermoscopy referral may be a viable method for skin cancer referral, however no economic investigations have occurred in Australia.

Objective: To assess the cost-effectiveness of teledermoscopy as a referral mechanism for skin cancer diagnosis and management in Australia.

Design: Cost-effectiveness analysis using a decision-analytic model.

Setting: Primary care.

Participants: Australian general population (modelled).

Intervention: We compared the costs of teledermoscopy referral (electronic referral containing digital dermoscopic images) versus usual care (a written referral letter) for specialist dermatologist review of a suspected skin cancer.

Main outcome measures: Cost and time in ‘days to clinical resolution’, where clinical resolution was defined as diagnosis by a dermatologist or excision by a general practitioner. Probabilistic sensitivity analysis was performed to examine the uncertainty of the main results.

Results: Time to clinical resolution was 26 days earlier with teledermoscopy referral compared with usual care alone (95%Credible interval (CrI) 13 to 38). The estimated mean cost difference between teledermoscopy referral ($318.39) versus usual care ($263.75) was $54.64 (95%CrI $22.69 to $97.35) per person. The incremental cost per day saved to clinical resolution was $2.10 (95%CrI $0.87 to $5.29).

Conclusion and Relevance: Using teledermoscopy for skin cancer referral and triage in Australia will cost $54.64 extra per case on average, but will result in clinical resolution 26 days sooner than usual care. Implementation recommendations depend on the preferences of the Australian health system decision makers for either lower cost or expedited clinical resolution. Further research around the clinical significance of expedited clinical resolution
and its importance for patients could inform implementation recommendations for the Australian setting.
Original languageEnglish
Pages (from-to)694-700
Number of pages7
JournalJAMA Dermatology
Issue number6
Early online date9 May 2018
Publication statusPublished - Jun 2018

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