Multicentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care: societal cost-benefit analysis

Objectives Comparison of real time teledermatology with outpatient dermatol ogy in terms of clinical outcomes, cost-benefits, and patient reattendance. Design Randomised controlled trial with a minimum follow up of three months . Setting Four health centres (two urban, two rural) and two regional hospita ls. Subjects 204 general practice patients requiring referral to dermatology se rvices; 102 were randomised to teledermatology consultation and. 102 to tra ditional outpatient consultation. Main outcome measures Reported clinical outcome of initial consultation, pr imary care and outpatient reattendance data, and cost-benefit analysis of b oth methods of delivering care. Results No major differences were found in the reported clinical outcomes o f teledermatology and conventional dermatology. Of patients randomised to t eledermatology, 55 (54%) were managed within primary care and 47 (46%) requ ired at least one hospital appointment. Of patients randomised to the conve ntional hospital outpatient consultation, 46 (45%) required at least one fu rther hospital appointment, 15 (15%) required general practice review and 3 0 (39%) no follow up visits. Clinical records showed that 42 (41%) patients seen by teledermatology attended subsequent hospital appointments compared with 41 (40%) patients seen conventionally. The net societal cost of the i nitial consultation was pound 132.10 pet patient for teledermatology and po und 48.73 for conventional consultation. Sensitivity analysis revealed that if each health centre had allocated one morning session a week to telederm atology and the average round trip to hospital had been 78 km instead of 26 km, the costs of the two methods of care would have been equal. Conclusions Real time teledermatology was clinically feasible but not cost effective compared with conventional dermatological outpatient care. Howeve r, if the equipment were purchased at current prices and the travelling dis tances greater, teledermatology would be a cost effective alternative to co nventional care.