Snoswell CL, et al. - In this decision-analytic modeling study, the researchers intended to evaluate the cost-effectiveness of teledermoscopy as a referral mechanism for skin cancer diagnosis and management in Australia. Results of this study suggested that using teledermoscopy for skin cancer referral and triage in Australia would cost A$54.64 extra per case on average but would result in clinical resolution 26 days sooner than usual care. Data revealed that implementation recommendations depend on the preferences of the Australian health system decision makers for either lower cost or expedited clinical resolution.

Methods

• Researchers performed cost-effectiveness analysis using a decision-analytic model of Australian primary care, informed by publicly available data.
• The costs of teledermoscopy referral (electronic referral containing digital dermoscopic images) vs usual care (a written referral letter) were compared for specialist dermatologist review of a suspected skin cancer.
• Cost and time in days to clinical resolution, where clinical resolution was defined as diagnosis by a dermatologist or excision by a general practitioner were the main outcomes.
• They performed probabilistic sensitivity analysis to examine the uncertainty of the main results.

Results

• Findings from the decision-analytic model demonstrated that the mean time to clinical resolution was 9 days (range, 1-50 days) with teledermoscopy referral compared with 35 days (range, 0-138 days) with usual care alone (difference, 26 days; 95% credible interval [CrI], 13-38 days).
• Data showed that the estimated mean cost difference between teledermoscopy referral (A$318.39) vs usual care (A$263.75) was A$54.64 (95% CrI, A$22.69-A$97.35) per person.
• It was noted that the incremental cost per day saved to clinical resolution was A$2.10 (95% CrI, A$0.87-A$5.29).