Efficacy and Cost-Effectiveness of Integrating Dermatologists into Primary Care

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Noticing the demands that dermatological disorders impose on primary care, a recent study explored the cost-effectiveness of integrating dermatologists into primary health care teams for skin condition evaluations. This practice would bypass general practitioners (GPs) as the initial point of contact. Data from the quasi-experimental observational study conducted in Finland suggested this model improves cost-efficiency, diagnostic accuracy, and management of skin conditions without compromising quality of care.¹

Background

Researchers found that skin conditions are among the most common reasons for GP consultations, with many requiring biopsies and specialist referrals.² Non-melanoma skin cancers, including basal and squamous cell carcinomas, were found to be the most prevalent malignancies globally, especially in fair-skinned populations.³ Evidence suggests that early dermatologist involvement reduces the number needed to excise (NNE) to detect melanoma, improving outcomes and overall patient satisfaction.

Methods and Materials

The study involved patients at 3 Finnish health centers from 2021 to 2022. Two centers implemented an integrated care model where dermatologists conducted initial evaluations, while a control center followed standard GP-led care. Inclusion criteria prioritized patients with suspicious skin findings, excluding those already receiving treatment for the same lesion. Quality of life (QoL) data and clinical parameters were collected pre- and post-intervention.

Primary outcomes included the incremental cost-effectiveness ratio (ICER) for managing malignant and pre-malignant conditions. Secondary outcomes encompassed total care costs, QoL metrics (PROMIS v1.2, Anxiety 4a), and clinical process outcomes such as biopsy rates, treatment modalities, and hospital referrals.

Care costs calculated in the study included labor, histopathological analysis, equipment, and specialist travel. Costs were assessed over a 12-month period post-initial contact, focusing on healthcare commissioner expenses.

Results 

In total, 362 participants were included: 186 in the intervention group and 176 in the control group. Researchers stated baseline demographics were similar, except for a higher prevalence of prior skin disease in the intervention group.

The study found intervention reduced the ICER by €852 ($897.64) per additional malignant or pre-malignant case detected and treated and by €381 ($401.41) per overall case. Total care chain costs were found to be significantly lower in the intervention group, driven by reductions in GP labor and histopathology expenses.

Patients in the intervention group had significantly fewer biopsies per detected malignancy (2.1 vs. 6.5, p < 0.005), according to the study, and required fewer hospital referrals. QoL improvements were noted to be comparable between groups, while diagnostic precision and the number of cases managed in primary care improved with dermatologist involvement.

Discussion and Conclusion

The study demonstrated that integrating dermatologists into primary care can streamline the care pathway for skin conditions, reducing costs and improving diagnostic accuracy. While prior studies have explored consultative specialist roles, researchers stated this direct replacement model proved more efficient and effective. Key cost savings arose from optimized use of specialist and GP time, reduced histopathology reliance, and fewer hospital referrals.

The study suggested future implementation challenges include addressing dermatologist availability and ensuring sufficient infrastructure. Researchers noted alternatives, such as teledermatology and AI-assisted diagnostic tools, may further enhance the model's scalability.

As for limitations, researchers noted the study was non-randomized, and patient self-selection may have influenced results. However, real-world applicability was enhanced by using actual unit costs and care pathways.

Overall, the study found that integrating dermatologists into primary care improves cost-effectiveness and management of skin disorders while maintaining care quality. It suggested that future research should refine criteria for direct dermatologist referrals and explore adjunctive technologies to optimize resource allocation.

References

1. Lovén M, Huilaja L, Paananen M, et al. The integration of dermatology experts into primary care to assess and treat patients with skin lesions is cost-effective: A quasi-experimental study. J EurAcad Dermatol Venereol. Published online December 2, 2024. doi:10.1111/jdv.20451
2. Koelink CJ, Kollen BJ, Groenhof F, et al. Skin lesions suspected of malignancy: an increasing burden on general practice. BMC Fam Pract. 2014;15:29. Published 2014 Feb 12. doi:10.1186/1471-2296-15-29
3. Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166(5):1069-1080. doi:10.1111/j.1365-2133.2012.10830.x