Community-Based Teledermatology for Urgent Suspected Skin Cancer: Health Economic Cost-Comparison and Discrete Event...

Area of Science:

• Dermatology
• Health Services Research
• Health Economics

Background:

• Skin cancer diagnosis faces challenges in the UK's National Health Service (NHS) due to rising incidence and specialist shortages.
• Traditional face-to-face appointments and standard teledermatology models struggle to overcome healthcare access barriers.
• Community-based decentralized teledermatology models show promise but require further research on cost and operational impact.

Purpose of the Study:

• To compare the financial costs and patient waiting times of a community-based teledermatology model against standard care for urgent suspected skin cancer.
• To evaluate the effectiveness of the Pathpoint eDerma system within the Northern Care Alliance NHS Foundation Trust.

Main Methods:

• An ambidirectional study design incorporating a cost comparison analysis (CCA) and discrete event simulation (DES).
• CCA compared the teledermatology model (n=563) with a synthetic comparator arm (n=4011) representing standard care.
• DES modeled operational impacts on patient waiting times over one year, using prospective and retrospective data with publicly available resource costs.

Main Results:

• The community-based teledermatology model resulted in a mean cost saving of £45 per referral.
• A significant reduction in diagnostic biopsies was observed (22% vs 48% in standard care), contributing to cost savings.
• Teledermatology decreased time to clinical diagnosis by 9.9 days, diagnosis communication by 54.2 days, and histopathological diagnosis by 62.8 days.

Conclusions:

• Community-based teledermatology is a cost-efficient strategy that shortens patient journeys for skin cancer diagnosis.
• While triage is faster, histopathology remains a bottleneck for further efficiency gains.
• Investment in technology to expedite downstream processes like histopathology is crucial for timely diagnoses.