Snoswell 2016 — Cost-effectiveness of store-and-forward teledermatology: systematic review
Citation
Snoswell C, Finnane A, Janda M, Soyer HP, Whitty JA. Cost-effectiveness of Store-and-Forward Teledermatology: A Systematic Review. JAMA Dermatol. 2016 Jun 1;152(6):702–708. DOI: 10.1001/jamadermatol.2016.0525. PMID 27074289.
Study design and population
Systematic review of 14 economic evaluations of store-and-forward teledermatology vs. conventional face-to-face (USA, Europe, Australia). CHEERS appraisal applied.
Reported metrics
- CHEERS scores 7–21 / 24 (median 17)
- Store-and-forward teledermatology cost-effective or cost-saving in the majority of included studies
- Cost-effectiveness improves with patient–dermatologist distance
- No pooled quantitative CI (heterogeneous endpoints precluded meta-analytic pooling)
Surrogate-to-outcome linkage
Connects the triage surrogate (avoided in-person referrals) to the health-economic outcome of cost-per-patient and cost-per-avoided-visit — the system-level-outcome channel of Pillar 1. Underpins the favourable cost-outcome trade-off claim for teledermatology / AI-triage pathway redesign.
CRIT1–7 appraisal
| Criterion | Score | Justification |
|---|---|---|
| CRIT1 Relevance | 3 | Direct — cost-effectiveness of teledermatology referral-optimisation pathways. |
| CRIT2 Methodology | 3 | Systematic review with CHEERS appraisal. |
| CRIT3 Reporting | 2 | Qualitative synthesis; no pooled CI. |
| CRIT4 Applicability | 3 | International; EU-relevant. |
| CRIT5 Evidence weight | 3 | Systematic review. |
| CRIT6 Risk of bias | 2 | Sparse evidence base; inconsistent perspectives; few cost-utility analyses. |
| CRIT7 Contribution | 3 | Core anchor for the health-economic leg of Domain 3. |
Aggregate: very strong.
Limitations and notes
Heterogeneous costing perspectives, currencies and time horizons; few formal cost-utility analyses; EU single-payer applicability variable.
Strength as anchor
Very strong. Only systematic-review-level evidence for cost-effectiveness in the domain. Paired with Datta 2015 (RCT-embedded cost-utility) and Vidal-Alaball 2018 (EU single-payer cost-minimisation) for depth.