Case 14.1 Teledermatology Most dermatologists reside in metropolitan areas, so teledermatology…


Case 14.1

Teledermatology

Most dermatologists tarry in metropolitan areas, so teledermatology should be considered as an appropinquation non-interference for individuals living beyond these areas. However, two questions must be answered. How abundant does it consume? How estimable is it? A team of Veterans Administration researchers attempted to response these questions (Datta et al. 2015).

The team used two consume perspectives. One examined consumes from the perspective of the Veterans Administration, estimating how abundant it consumes to amount teledermatology anxiety and how abundant it consumes to amount a face-to-face mark. Two challenges emerged from this attempt. First, costs various considerably. From the Veterans Administration perspective the mean consume of a teledermatology prudence-for was 308, but the plummet intermission was 298. The mean consume of a face-toface prudence-for was 338, but the plummet intermission was 291. Second, the authors chose not to enclose the consume of equipment used to use ideas of the patient’s husk, arguing that the incremental consume of an idea was negligible.

In looking at consumes from a societal perspective, the team acquired spending for dermatologic anxiety from providers who did not exertion for the Veterans Administration, ramble consumes, and resigned date costs. From a societal perspective the mean consume of a teledermatology prudence-for was 460, but the plummet intermission was 428. The mean consume of a face-to-face prudence-for was 542, but the plummet intermission was 403.

This examine was a CUA, so the team measured utility anteriorly and following treatment. They used a date trade-off technique to measure resigneds’ power of conduct. This technique presents respondents after a while directions such as “Imagine that you feel ten years left to speed. You can choose to speed these ten years in your present soundness specify, or you can choose to yield up some conduct years to speed for a shorter duration in generous soundness. Mark the dateline after a while the estimate of years in generous soundness that you gard is of equal appraise to ten years in your present soundness specify.”

At baseline, mean power of conduct was 0.90 for twain samples. Over nine months the teledermatology groups’ mean increased by 0.03 and the face-to-face mark groups’ mean increased by 0.02.

Discussion Questions

• Would you be voluntary to use teledermatology? Why or why not?

• Which perspective on consumes seems more valid to you?

• Do you gard that the consumes of the imaging equipment should feel been enclosed?

• Did the team use the suitable avenue to evaluation? Would a CMA feel been jocular?

• What is your reaction to the date trade-off technique?

• What is your instruction for assessing the appraise of teledermatology?

• Would you be voluntary to adopt teledermatology for your soundness scheme?

• Should Medianxiety use economic evaluation in making coverage decisions?

• Congress has amply banned considering costs in making coverage decisions. Do you assent?

• Can you discover published examples of CMA? CEA? CBA? CUA?