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 effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas One urban and one rural 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 outpatient dermatology referral 126 patients 46 were randomized to a telemedicine consultation and 148 54 to a conventional hospital outpatient consultation Of those seen by telemedicine 61 were registered with an urban practice compared with 71 of those seen conventionally The clinical outcomes of the two types of consultation were similar almost half the patients were managed after a single consultation with the dermatologist The observed marginal cost per patient of the initial realtime teledermatology consultation was 52 85 Pounds for those in urban areas and 59 93 Pounds per patient for those from rural areas The observed marginal cost of the initial conventional consultation was 47 13 Pounds for urban patients and 48 77 Pounds for rural patients The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas mainly because of the fixed equipment costs Sensitivity analysis using a real world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation