A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: an urban versus rural perspective

A randomized controlled trial was carried out to measure the cost-effective ness of realtime teledermatology compared with conventional outpatient derm atology care for patients from urban and rural areas. One urban and one rur al health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpat ient dermatology referral -126 patients (46%) were randomized to a telemedi cine consultation and 148 (54%) to a conventional hospital outpatient consu ltation. Of those seen by telemedicine, 61% were registered with an urban p ractice, compared with 71% of those seen conventionally. The clinical outco mes of the two types of consultation were similar - almost half the patient s were managed after a single consultation with the dermatologist. The obse rved marginal cost per patient of the initial realtime teledermatology cons ultation was f52.85 for those in urban areas and f59.93 per patient for tho se from rural areas. The observed marginal cost of the initial conventional consultation was f47.13 for urban patients and f48.77 for rural patients. The total observed costs of teledermatology were higher than the costs of c onventional care in both urban and rural areas, mainly because of the fixed equipment costs. Sensitivity analysis using a real-world scenario showed t hat in urban areas the average costs of the telemedicine and conventional c onsultations were about equal, while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultat ion.