Synthesizing Health Service Utilization Data for a Complex Intervention: A Case Study of Teledermatology
Author(s)
Laura Rouncivell, MSc, Orla Jenkins, MSc, Joan Quigley, MSc, Derek Corrigan, PhD, Connie Bulos, MSc, Shibu Shrestha, MSc, Roberta Gugles, MSc, Emma Reece, PhD, Patricia Harrington, PhD, Conor Teljeur, PhD, Mairin Ryan, PhD.
Health Information and Quality Authority, Dublin, Ireland.
Health Information and Quality Authority, Dublin, Ireland.
OBJECTIVES: Long waiting lists and delayed access to secondary dermatological care are challenges facing many healthcare systems. Teledermatology is being adopted to manage referrals and optimise health service utilisation (HSU), by enabling remote triage, management, and potentially reducing unnecessary face-to-face (FTF) appointments. Health technology assessment (HTA) of service delivery changes is challenging as evidence for these complex interventions comprise mostly of real-world data rather than randomised controlled trials (RCTs). We used teledermatology-supported referral management to illustrate methods for synthesising HSU data.
METHODS: The clinical efficacy, effectiveness, associated HSU, and safety of teledermatology-supported referral management compared with FTF consultations was evaluated through systematic review. Searches (to February 2025), screening and data extraction followed our registered protocol (CRD42024608084). Comparative study designs were considered including single-centre experiences. Risk of bias (ROB) was assessed using the Cochrane revised ROB tool for RCTs and the ROB in Non-randomised Studies of Interventions (ROBINS-I) tool for other designs. Meta-analysis was undertaken where appropriate, an evidence and gap map developed, and GRADE applied to outcomes pertinent for decision-making.
RESULTS: We identified 10 RCTs, two quasi-RCTs, 76 prospective non-RCTs, and 32 retrospective non-RCTs. Sample sizes ranged from 12 and 106,500, with mostly single-centre studies. Significant clinical and methodological heterogeneity increased the complexity of synthesis and interpretation. Sixty-one studies (eight RCTs) reported HSU data across ten outcomes. Synthesis required a mixed-methods approach due to substantial real-world data. Tables, bubble plots and narrative summaries supported interpretation of the evidence-base. GRADE was applied to one HSU outcome (percentage avoided appointments). Overall findings were summarised using an evidence and gap map to assess the balance of outcome data for the intervention.
CONCLUSIONS: Combining RCT and real-world data can be challenging, particularly for HSU outcomes. A teledermatology case study was used to present a variety of methods that can aid evidence synthesis of a complex intervention in HTA.
METHODS: The clinical efficacy, effectiveness, associated HSU, and safety of teledermatology-supported referral management compared with FTF consultations was evaluated through systematic review. Searches (to February 2025), screening and data extraction followed our registered protocol (CRD42024608084). Comparative study designs were considered including single-centre experiences. Risk of bias (ROB) was assessed using the Cochrane revised ROB tool for RCTs and the ROB in Non-randomised Studies of Interventions (ROBINS-I) tool for other designs. Meta-analysis was undertaken where appropriate, an evidence and gap map developed, and GRADE applied to outcomes pertinent for decision-making.
RESULTS: We identified 10 RCTs, two quasi-RCTs, 76 prospective non-RCTs, and 32 retrospective non-RCTs. Sample sizes ranged from 12 and 106,500, with mostly single-centre studies. Significant clinical and methodological heterogeneity increased the complexity of synthesis and interpretation. Sixty-one studies (eight RCTs) reported HSU data across ten outcomes. Synthesis required a mixed-methods approach due to substantial real-world data. Tables, bubble plots and narrative summaries supported interpretation of the evidence-base. GRADE was applied to one HSU outcome (percentage avoided appointments). Overall findings were summarised using an evidence and gap map to assess the balance of outcome data for the intervention.
CONCLUSIONS: Combining RCT and real-world data can be challenging, particularly for HSU outcomes. A teledermatology case study was used to present a variety of methods that can aid evidence synthesis of a complex intervention in HTA.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA308
Topic
Health Technology Assessment, Methodological & Statistical Research, Study Approaches
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Sensory System Disorders (Ear, Eye, Dental, Skin)