A cost-minimization analysis of the societal costs of realtime teledermatology compared with conventional care: results from a randomized controlled trial in New Zealand

A randomized controlled trial was carried out to measure the societal costs of realtime teledermatology compared with those of conventional hospital c are in New Zealand. Two rural health centres were linked to a specialist ho spital via ISDN at 128 kbit/s. Over 10 months, 203 patients were referred f or a specialist dermatological consultation and 26 were followed up, giving a total of 229 consultations. Fifty-four per cent were randomized to the t eledermatology consultation and 46% to the conventional hospital consultati on. A cost-minimization analysis was used to calculate the total costs of b oth types of dermatological consultation. The total cost of the 123 teleder matology consultations was NZ$34,346 and the total cost of the 106 conventi onal hospital consultations was NZ$30,081. The average societal cost of the teledermatology consultation was therefore NZ$279.23 compared with NZ$283. 79 for the conventional hospital consultation. The marginal cost of seeing an additional patient was NZ$135 via teledermatology and NZ$284 via convent ional hospital appointment. From a societal viewpoint, and assuming an equa l outcome, teledermatology was a more cost-efficient use of resources than conventional hospital care.