Implementation of a teledermatology (TD) triage system within a dermatology department at a hospital and trauma center was associated with a significant reduction in the cost of managing patients, according to study data published in JAMA Dermatology.

The findings are based on a comparison of the organization-wide cost of managing newly referred dermatology patients within a TD triage system vs a conventional dermatology care model at the Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG). Researchers conducted a retrospective cost minimization analysis of 2098 patients referred to the dermatology department at the ZSFG from June 1 to December 31, 2017. The TD triage system was implemented in January 2015.

The main outcome was the mean cost to the healthcare organization to manage newly referred dermatology patients with or without TD triage. The study authors constructed decision-tree models to characterize possible care paths with TD triage and within a conventional dermatology care model. The costs associated with primary care visits, dermatology visits, and TD visits were then applied to the decision-tree models to estimate the mean cost of managing patients after each care path for 6 months.


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A total of 2098 patients was included in the analysis (1154 men [55.0%]; mean [standard deviation, SD] age, 53.4 [16.8] years); 1099 patients (52.4%) had Medi-Cal insurance, and 879 (41.9%) identified as non-White. In the decision-tree model with TD triage, the mean (SD) cost per patient to the healthcare organization was $559.84 ($319.29). In the decision-tree model for conventional dermatology care, the mean (SD) cost per patient was $699.96 ($390.24).

“The TD model demonstrated a statistically significant mean (standard error [SE]) cost savings of $140.12 ($11.01) per patient,” according to the study authors. The analysis estimates an annual savings of $441,378, given an annual dermatology referral volume of 3150 patients.

“A promising aspect of our findings is that TD produced cost savings even though the analysis included TD implementation costs,” the researchers commented. “Many costs associated with the implementation of TD, including the purchase of equipment and the training of personnel, tend to be front loaded and have been suggested as the reason for the increased relative cost of TD in previous analyses.”

Among several study limitations, the analysis included only personnel and direct TD costs without accounting for other fixed costs such as rent, supplies, and utilities. Also, the researchers did not account for revenue generated from billing, and they lacked data analyzing clinical outcomes in the ZSFG dermatology patients before and after TD implementation.

“Implementation of TD at the ZSFG was associated with a significant reduction in the mean cost of managing patients referred to the dermatology department,” stated the study authors. “Therefore, TD has the potential to produce cost savings when applied in closed healthcare systems. Areas of future investigation include analyzing TD’s impact on clinician workload, clinical outcomes, and emergency department visits.”

Disclosures: One of the study authors reported an affiliation with a technology company. Please see the original reference for a full list of disclosures.

Reference

Zakaria A, Miclau TA, Maurer T, Leslie KS, Amerson E. Cost minimization analysis of a teledermatology triage system in a managed care setting. Published online November 18, 2020. JAMA Dermatol. doi:10.1001/jamadermatol.2020.4066