Original articles
An Economic Analysis of Presurgical Teledermatology in Patients with Nonmelanoma Skin Cancer
Teledermatología Prequirúrgica en Pacientes con Cáncer Cutáneo no Melanoma. Evaluación Económica
L. Ferrándiza,
, D. Moreno-Ramíreza, A. Ruiz-de-Casasa, A. Nieto-Garcíab, P. Moreno-Álvarezc, R. Galdeanod, F.M. Camachoa
Corresponding author
lferrandiz@e-derma.org
Correspondence: Departamento de Dermatología, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani, s/n, 41009 Sevilla, Spain.
Correspondence: Departamento de Dermatología, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani, s/n, 41009 Sevilla, Spain.
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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"apellidos" => "Ferrándiz" "email" => array:1 [ 0 => "lferrandiz@e-derma.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "D." "apellidos" => "Moreno-Ramírez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Ruiz-de-Casas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Nieto-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 4 => array:3 [ "nombre" => "P." 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Dr. Fedriani, s/n, 41009 Sevilla, Spain." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Teledermatología Prequirúrgica en Pacientes con Cáncer Cutáneo no Melanoma. Evaluación Económica" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2008-04-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec84332" "palabras" => array:7 [ 0 => "teledermatology" 1 => "presurgical teledermatology" 2 => "dermatologic surgery" 3 => "skin cancer" 4 => "economic analysis" 5 => "cost-effectiveness" 6 => "health costs" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84331" "palabras" => array:7 [ 0 => "teledermatología" 1 => "teledermatología prequirúrgica" 2 => "cirugía dermatológica" 3 => "cáncer de piel" 4 => "evaluación económica" 5 => "coste-efectividad" 6 => "costes sanitarios" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to undertake an economic analysis of presurgical teledermatology, comparing it with a conventional health care approach.</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. 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.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">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.</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.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Evaluación económica de la teledermatología prequirúrgica, comparándola con la asistencia convencional.</p> <span class="elsevierStyleSectionTitle">Material y método</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 5 | 8 |
| 2024 October | 57 | 59 | 116 |
| 2024 September | 41 | 34 | 75 |
| 2024 August | 68 | 60 | 128 |
| 2024 July | 56 | 41 | 97 |
| 2024 June | 50 | 31 | 81 |
| 2024 May | 39 | 32 | 71 |
| 2024 April | 50 | 34 | 84 |
| 2024 March | 51 | 40 | 91 |
| 2024 February | 42 | 39 | 81 |
| 2024 January | 39 | 35 | 74 |
| 2023 December | 41 | 36 | 77 |
| 2023 November | 41 | 39 | 80 |
| 2023 October | 38 | 19 | 57 |
| 2023 September | 31 | 24 | 55 |
| 2023 August | 28 | 18 | 46 |
| 2023 July | 24 | 47 | 71 |
| 2023 June | 26 | 22 | 48 |
| 2023 May | 28 | 22 | 50 |
| 2023 April | 20 | 24 | 44 |
| 2023 March | 27 | 17 | 44 |
| 2023 February | 24 | 20 | 44 |
| 2023 January | 31 | 32 | 63 |
| 2022 December | 25 | 44 | 69 |
| 2022 November | 16 | 39 | 55 |
| 2022 October | 18 | 28 | 46 |
| 2022 September | 13 | 36 | 49 |
| 2022 August | 20 | 37 | 57 |
| 2022 July | 11 | 16 | 27 |
| 2022 June | 15 | 28 | 43 |
| 2022 May | 22 | 31 | 53 |
| 2022 April | 30 | 40 | 70 |
| 2022 March | 33 | 51 | 84 |
| 2022 February | 46 | 33 | 79 |
| 2022 January | 56 | 33 | 89 |
| 2021 December | 35 | 40 | 75 |
| 2021 November | 19 | 34 | 53 |
| 2021 October | 31 | 50 | 81 |
| 2021 September | 53 | 34 | 87 |
| 2021 August | 46 | 29 | 75 |
| 2021 July | 17 | 34 | 51 |
| 2021 June | 13 | 46 | 59 |
| 2021 May | 29 | 33 | 62 |
| 2021 April | 66 | 49 | 115 |
| 2021 March | 37 | 21 | 58 |
| 2021 February | 32 | 31 | 63 |
| 2021 January | 32 | 21 | 53 |
| 2020 December | 22 | 16 | 38 |
| 2020 November | 17 | 26 | 43 |
| 2020 October | 17 | 11 | 28 |
| 2020 September | 16 | 9 | 25 |
| 2020 August | 20 | 22 | 42 |
| 2020 July | 25 | 9 | 34 |
| 2020 June | 14 | 26 | 40 |
| 2020 May | 38 | 22 | 60 |
| 2020 April | 21 | 21 | 42 |
| 2020 March | 21 | 24 | 45 |
| 2020 February | 1 | 0 | 1 |
| 2020 January | 0 | 1 | 1 |
| 2019 December | 0 | 5 | 5 |
| 2019 November | 0 | 5 | 5 |
| 2019 October | 0 | 5 | 5 |
| 2019 September | 0 | 1 | 1 |
| 2019 August | 0 | 3 | 3 |
| 2019 July | 0 | 3 | 3 |
| 2019 May | 0 | 43 | 43 |
| 2019 April | 0 | 14 | 14 |
| 2019 March | 0 | 4 | 4 |
| 2019 February | 0 | 5 | 5 |
| 2018 December | 0 | 6 | 6 |
| 2018 October | 0 | 1 | 1 |
| 2018 September | 0 | 3 | 3 |
| 2018 August | 0 | 1 | 1 |
| 2018 July | 0 | 5 | 5 |
| 2018 June | 0 | 2 | 2 |
| 2018 May | 0 | 3 | 3 |
| 2018 April | 0 | 7 | 7 |
| 2018 March | 0 | 3 | 3 |
| 2018 February | 7 | 1 | 8 |
| 2018 January | 8 | 5 | 13 |
| 2017 December | 12 | 7 | 19 |
| 2017 November | 8 | 1 | 9 |
| 2017 October | 10 | 13 | 23 |
| 2017 September | 8 | 1 | 9 |
| 2017 August | 6 | 6 | 12 |
| 2017 July | 20 | 4 | 24 |
| 2017 June | 12 | 6 | 18 |
| 2017 May | 9 | 13 | 22 |
| 2017 April | 12 | 11 | 23 |
| 2017 March | 11 | 23 | 34 |
| 2017 February | 11 | 13 | 24 |
| 2017 January | 6 | 9 | 15 |
| 2016 December | 17 | 5 | 22 |
| 2016 November | 12 | 6 | 18 |
| 2016 October | 19 | 11 | 30 |
| 2016 September | 21 | 10 | 31 |
| 2016 August | 24 | 10 | 34 |
| 2016 July | 23 | 3 | 26 |
| 2016 June | 11 | 7 | 18 |
| 2016 May | 7 | 4 | 11 |
| 2016 April | 10 | 12 | 22 |
| 2016 March | 5 | 3 | 8 |
| 2016 February | 12 | 1 | 13 |
| 2016 January | 4 | 2 | 6 |
| 2015 December | 8 | 1 | 9 |
| 2015 November | 15 | 4 | 19 |
| 2015 October | 9 | 4 | 13 |
| 2015 September | 6 | 3 | 9 |
| 2015 August | 14 | 3 | 17 |
| 2015 July | 27 | 6 | 33 |
| 2015 June | 29 | 6 | 35 |
| 2015 May | 53 | 8 | 61 |
| 2015 April | 31 | 8 | 39 |
| 2015 March | 23 | 9 | 32 |
| 2015 February | 19 | 7 | 26 |
| 2015 January | 28 | 11 | 39 |
| 2014 December | 22 | 4 | 26 |
| 2014 November | 24 | 8 | 32 |
| 2014 October | 38 | 13 | 51 |
| 2014 September | 31 | 16 | 47 |
| 2014 August | 30 | 14 | 44 |
| 2014 July | 38 | 21 | 59 |
| 2014 June | 43 | 13 | 56 |
| 2014 May | 35 | 18 | 53 |
| 2014 April | 27 | 13 | 40 |
| 2014 March | 50 | 13 | 63 |
| 2014 February | 24 | 18 | 42 |
| 2014 January | 38 | 16 | 54 |
| 2013 December | 41 | 12 | 53 |
| 2013 November | 29 | 22 | 51 |
| 2013 October | 36 | 14 | 50 |
| 2013 September | 29 | 15 | 44 |
| 2013 August | 19 | 21 | 40 |
| 2013 July | 24 | 19 | 43 |
| 2013 June | 18 | 21 | 39 |
| 2013 May | 21 | 21 | 42 |
| 2013 April | 19 | 25 | 44 |
| 2013 March | 27 | 23 | 50 |
| 2013 February | 37 | 15 | 52 |
| 2013 January | 13 | 4 | 17 |
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