Cost-effectiveness of store-and-forward teledermatology: A systematic review

Importance: Teledermatology is a topical clinical approach being trialled in Australia and overseas (1). With a majority of dermatologists residing in metropolitan areas, teledermatology provides an apparent low cost and convenient means of access for individuals living outside these areas (1, 2). It is important that any proposed new addition to a healthcare system is assessed on the ground of economic cost and effectiveness. Objective: To summarise and evaluate the current economic evidence comparing store-and-forward teledermatology (S&FTD) with conventional face-to-face (FTF) care. Evidence Review: Search terms with appropriate amendments were used to return S&FTD articles that included economic analysis. Six databases were searched; title, abstract and full text reviews were conducted by two researchers. References of all unique returned articles were searched by hand. (3) Findings: Eleven articles were selected for inclusion; consisting of once cost-analysis, five cost-minimisation analyses, three cost-effectiveness analyses and two cost-utility analyses. The Consolidated Health Economic Evaluation Reporting Standards checklist was used to evaluate quality, scores ranged from 7 to 21 out of a possible 24 points, with a median score of 17. Conclusions and Relevance: Current evidence is sparse, but suggests that S&FTD can be cost-effective. It appears to be cost-effective when it is used as a triage mechanism to reduce FTF appointment requirements. The cost-effectiveness of S&FTD increases when patients are required to travel further distances to access dermatology services. Further economic research is required for the emerging S&FTD which uses dermatoscopes in combination with smartphone applications, and around the possibility and consequences of patients self-capturing and transmitting images