Tele-expertise for diagnosis of skin lesions is cost-effective in a prison setting: A retrospective cohort study of 450 patients

Abstract

Context: The prevalence of skin diseases among prisoners is higher than in the general population. Diagnosing and treating these lesions require a dermatologic advice. A tele-expertise network in dermatology for prisoners including 8 health facilities in prison and 2 hospital dermatological departments was developed to improve access to dermatologists' expertise in correctional facilities. Our objective was to evaluate the effectiveness and costs of tele-expertise in dermatology for prisoners.

Methods: We carried out a retrospective cohort study on data collected by the information system of the tele-expertise network. We used the MAST (Model for ASsessment of Telemedicine) model to perform a multidimensional assessment including the proportion of patients with a completed treatment plan for the skin lesions, the proportion of technical problems, the quality of the pictures, the investment and operating costs and the satisfaction of the professionals.

Results: Mean patient age was 34.2 years with 90% men. 511 requests for 450 patients were initiated. The delay from the connection to the tele-expertise software to the validation of the request was inferior to 7 min for 50% of the requests and inferior to 30 min for 85% of the requests. Overall, with tele-expertise, 82% of the patients had a completed treatment plan for the skin lesions, with 2.9% of all patients requiring a later face-to-face appointment or hospitalization, to be compared to a proportion of 35% of patients with a completed treatment plan when tele-expertise was not available. The most frequent lesions were acnea (22%) and atopic dermatitis (18%). The mean cost for one completed treatment plan was €184 by tele-expertise and €315 without tele-expertise. Tele-expertise was well accepted among physicians with all responders (n = 9) willing to continue using it.

Conclusion: Tele-expertise is a dominant intervention in comparison to a face-to face consultation taking into account the cost of transportation and the proportion of canceled appointments and is acceptable for physicians.

Trial registration: NCT02309905.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Simplified sequence diagram of the tele-expertise procedure.

loop: The bordered part of the diagram restarts as long as the condition is true. alt: The bordered part of the diagram occurs only if the condition is true.

Fig 2. Flowchart of the requests.

Multiple requests could be performed for one patient.

Fig 3. Mean cost for one completed treatment plan depending on the number of patients.

As investment costs are substantial and fixed, economies of scales are possible in the tele-expertise group. As soon as the number of annual patients reaches 186, the mean cost of one completed treatment plan equals the cost without tele-expertise.

Fig 4. Tornado diagram of the sensitivity analysis of the mean cost for one completed treatment plan.

Costs determinants are listed vertically, ordered so that the largest bar (the most sensitive data) appears at the top of the chart, and the smallest bar at the bottom. The baseline is €184. *With 50 satisfactory requests at each site.