Multicentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care: societal cost-benefit analysis

British Medical Journal,  May 6, 2000  by R Wootton,  S E Bloomer,  R Corbett,  D J Eedy,  N Hicks,  H E Lotery,  C Mathews,  J Paisley,  K Steele,  M A Loane

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                                        Calculation

Variable costs

Consultant time                         [pounds sterling] 150/60
                                          minxconsultation time(*)
General practitioner time               [pounds sterling] 114/60
                                          minx15.7(*)
Patient travel                          Average travel
                                          cost([dagger])
Patient time                            Average cost of patient
                                          time([dagger])
Total

Fixed costs([double dagger])

Cost of capital                         49 456x6%/102
Depreciation                            49 456/7=7065/102
Telecommunications costs                2709/102
Total
Total variable plus fixed costs

Savings

Non-referrals due to general            20% of conventional
  practitioners' learning([dagger])       consultant cost
                                        20% of patient travel cost
                                        20% of cost of patient time
Total

Benefits

Cost of equivalent training([dagger])   6.3x((114x8)+60)/102
Total savings and benefits
Net societal cost                       Total costs-
                                          (savings+benefits)

                                           Telemedicine
                                        ([pounds sterling])

Variable costs

Consultant time                                39.25
General practitioner time                      29.83
Patient travel                                  1.89
Patient time                                    5.99
Total                                          76.96

Fixed costs([double dagger])

Cost of capital                                29.09
Depreciation                                   69.27
Telecommunications costs                       26.56
Total                                         124.92
Total variable plus fixed costs               201.88

Savings

Non-referrals due to general                    6.95
  practitioners' learning([dagger])
                                                0.89
                                                1.90
Total                                           9.74

Benefits

Cost of equivalent training([dagger])          60.04
Total savings and benefits                     69.78
Net societal cost                             132.10

                                           Conventional
                                        ([pounds sterling])

Variable costs

Consultant time                                34.75
General practitioner time
Patient travel                                  4.46
Patient time                                    9.52
Total                                          48.73

Fixed costs([double dagger])

Cost of capital                                  0
Depreciation                                     0
Telecommunications costs                         0
Total                                            0
Total variable plus fixed costs                48.72

Savings

Non-referrals due to general                     0
  practitioners' learning([dagger])
                                                 0
                                                 0
Total                                            0

Benefits

Cost of equivalent training([dagger])
Total savings and benefits                       0
Net societal cost                              48.73