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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">In patients with nonmelanoma skin cancer&#44; store-and-forward teledermatology allows satisfactory diagnosis and surgical planning&#44; thus shortening waiting lists and reducing travel requirements for patients in special situations&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to undertake an economic analysis of presurgical teledermatology&#44; comparing it with a conventional health care approach&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">The cost and cost-effectiveness of presurgical teledermatology were analyzed from a societal perspective in the setting of a public hospital with a corporate intranet&#46; The mean delay in surgery was used to measure effectiveness&#46; Over a 12-month period&#44; teledermatology was used in 134 patients with nonmelanoma skin cancer&#46; The unit cost of each intervention &#40;teledermatology and conventional health care approach&#41;&#44; the cost ratio between the most and least expensive alternative&#44; and the incremental cost-effectiveness ratio were calculated&#46; We distinguished between 2 groups of patients&#58; those with and those without physical impediments for travel&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The unit cost of the patients in whom teledermatology was used was 1156&#46;40 compared to 1278&#46;42 per patient in the conventional system&#59; the conventional system was therefore 1&#46;78 times more expensive than presurgical teledermatology&#46; Teledermatology was more cost-effective&#44; with an incremental cost-effectiveness ratio of 13&#46;10 per patient and per day of delay avoided in patients without impediments for travel and 14&#46;87 in those with impediments for travel&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p class="elsevierStyleSimplePara elsevierViewall">Teledermatology used for remote presurgical planning and preparation in patients with nonmelanoma skin cancer is more cost-effective than the conventional referral system in a health setting with a communication network available&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">En pacientes con c&#225;ncer de piel no melanoma la teledermatolog&#237;a diferida permite una adecuada aproximaci&#243;n diagn&#243;stica y planificaci&#243;n quir&#250;rgica&#44; acortando la demora y evitando desplazamientos en pacientes con situaciones especiales&#46;</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Evaluaci&#243;n econ&#243;mica de la teledermatolog&#237;a prequir&#250;rgica&#44; compar&#225;ndola con la asistencia convencional&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p class="elsevierStyleSimplePara elsevierViewall">Descripci&#243;n de costes y an&#225;lisis coste-efectividad bajo una perspectiva social de la teledermatolog&#237;a prequir&#250;rgica en el &#225;mbito de un hospital p&#250;blico dotado de infraestructura de redes &#40;intranet corporativa&#41;&#46; Se consider&#243; como medida de efectividad la demora media hasta la intervenci&#243;n quir&#250;rgica&#46; Durante un per&#237;odo de 12 meses se atendieron un total de 134 pacientes con c&#225;ncer no melanoma mediante teledermatolog&#237;a&#44; calculando el coste unitario de cada intervenci&#243;n &#40;teledermatolog&#237;a y asistencia convencional&#41;&#44; la ratio de coste entre la alternativa m&#225;s cara y la m&#225;s barata y la ratio de coste-efectividad incremental&#46; Se diferenciaron dos grupos de pacientes&#44; con y sin dificultades f&#237;sicas para el desplazamiento&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El coste unitario de los pacientes atendidos mediante teledermatolog&#237;a fue de 156&#44;40 euros&#44; frente a 278&#44;42 euros por paciente en el sistema convencional&#59; la asistencia convencional result&#243; 1&#44;78 veces m&#225;s cara que la teledermatolog&#237;a prequir&#250;rgica&#46; La teledermatolog&#237;a demostr&#243; ser m&#225;s coste-efectiva&#44; con una ratio coste-efectividad incremental de 3&#44;10 euros ahorrados por paciente y d&#237;a de demora evitado en pacientes sin dificultades para el desplazamiento&#44; y de 4&#44;87 euros en pacientes con dificultades para el desplazamiento&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">La teledermatolog&#237;a orientada a la planificaci&#243;n y preparaci&#243;n prequir&#250;rgica remota de pacientes con c&#225;ncer no melanoma es una intervenci&#243;n m&#225;s coste-efectiva que el sistema de derivaci&#243;n convencional en un medio sanitario dotado de infraestructura de redes de comunicaci&#243;n&#46;</p>"
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Vol. 99. Issue 10.
Pages 795-802 (December 2008)
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Vol. 99. Issue 10.
Pages 795-802 (December 2008)
Original articles
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An Economic Analysis of Presurgical Teledermatology in Patients with Nonmelanoma Skin Cancer
Teledermatología Prequirúrgica en Pacientes con Cáncer Cutáneo no Melanoma. Evaluación Económica
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L. Ferrándiza,
Corresponding author
lferrandiz@e-derma.org

Correspondence: Departamento de Dermatología, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani, s/n, 41009 Sevilla, Spain.
, D. Moreno-Ramíreza, A. Ruiz-de-Casasa, A. Nieto-Garcíab, P. Moreno-Álvarezc, R. Galdeanod, F.M. Camachoa
a Departamento de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Sevilla, Spain
c Unidad Clínica San José, Sevilla, Spain
d Atención Primaria, Distrito de Atención Primaria Sevilla, Sevilla Spain
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Abstract
Introduction

In patients with nonmelanoma skin cancer, store-and-forward teledermatology allows satisfactory diagnosis and surgical planning, thus shortening waiting lists and reducing travel requirements for patients in special situations.

Objective

The aim of this study was to undertake an economic analysis of presurgical teledermatology, comparing it with a conventional health care approach.

Material and methods

The cost and cost-effectiveness of presurgical teledermatology were analyzed from a societal perspective in the setting of a public hospital with a corporate intranet. The mean delay in surgery was used to measure effectiveness. Over a 12-month period, teledermatology was used in 134 patients with nonmelanoma skin cancer. The unit cost of each intervention (teledermatology and conventional health care approach), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated. We distinguished between 2 groups of patients: those with and those without physical impediments for travel.

Results

The unit cost of the patients in whom teledermatology was used was 1156.40 compared to 1278.42 per patient in the conventional system; the conventional system was therefore 1.78 times more expensive than presurgical teledermatology. Teledermatology was more cost-effective, with an incremental cost-effectiveness ratio of 13.10 per patient and per day of delay avoided in patients without impediments for travel and 14.87 in those with impediments for travel.

Conclusion

Teledermatology used for remote presurgical planning and preparation in patients with nonmelanoma skin cancer is more cost-effective than the conventional referral system in a health setting with a communication network available.

Key words:
teledermatology
presurgical teledermatology
dermatologic surgery
skin cancer
economic analysis
cost-effectiveness
health costs
Resumen
Introducción

En pacientes con cáncer de piel no melanoma la teledermatología diferida permite una adecuada aproximación diagnóstica y planificación quirúrgica, acortando la demora y evitando desplazamientos en pacientes con situaciones especiales.

Objetivo

Evaluación económica de la teledermatología prequirúrgica, comparándola con la asistencia convencional.

Material y método

Descripción de costes y análisis coste-efectividad bajo una perspectiva social de la teledermatología prequirúrgica en el ámbito de un hospital público dotado de infraestructura de redes (intranet corporativa). Se consideró como medida de efectividad la demora media hasta la intervención quirúrgica. Durante un período de 12 meses se atendieron un total de 134 pacientes con cáncer no melanoma mediante teledermatología, calculando el coste unitario de cada intervención (teledermatología y asistencia convencional), la ratio de coste entre la alternativa más cara y la más barata y la ratio de coste-efectividad incremental. Se diferenciaron dos grupos de pacientes, con y sin dificultades físicas para el desplazamiento.

Resultados

El coste unitario de los pacientes atendidos mediante teledermatología fue de 156,40 euros, frente a 278,42 euros por paciente en el sistema convencional; la asistencia convencional resultó 1,78 veces más cara que la teledermatología prequirúrgica. La teledermatología demostró ser más coste-efectiva, con una ratio coste-efectividad incremental de 3,10 euros ahorrados por paciente y día de demora evitado en pacientes sin dificultades para el desplazamiento, y de 4,87 euros en pacientes con dificultades para el desplazamiento.

Conclusión

La teledermatología orientada a la planificación y preparación prequirúrgica remota de pacientes con cáncer no melanoma es una intervención más coste-efectiva que el sistema de derivación convencional en un medio sanitario dotado de infraestructura de redes de comunicación.

Palabras clave:
teledermatología
teledermatología prequirúrgica
cirugía dermatológica
cáncer de piel
evaluación económica
coste-efectividad
costes sanitarios
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Copyright © 2008. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
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