Acta Dermato-Venereologica Issue No. 97-5 97-5CompleteContent | Page 30

663 SHORT COMMUNICATION Cost-effectiveness in Psychodermatology: A Case Series Jonathan M. R. GOULDING, Natasha HARPER*, Liam KENNEDY and Kate R. MARTIN Department of Dermatology, Heart of England NHS Foundation Trust, Solihull Hospital, Lode Lane, Solihull, B91 2JL, UK. E-mail: Natasha. [email protected] Accepted Jan 24, 2017; Epub ahead of print Jan 25, 2017 Patients with psychodermatological problems are nu- merous, and can be challenging to manage within the constraints of general dermatology clinics. Despite this, psychodermatology services remain limited in the UK and globally. A study in 2012 found that only 6% of de- partments in the UK had a dedicated psychodermatology service (1). Commissioners may be reluctant to fund such multidisciplinary services, perceiving them to be costly. This case series, along with two other published studies, shows the reverse to be true (2, 3). other complaints including widespread pain, visual loss, headaches, weakness, incontinence, twitching, recurrent abdominal pain and dyspnoea. She had been thoroughly assessed by multiple departments over 5 years. She was eventually diagnosed with factitious skin disease and medically unexplained symptoms. Prior to referral, the cost of investigating and treating her skin complaint was £5,555 (€6,190). A conservative estimate of the cost with regard to her additional symptoms was £14,979 (€16,692). Psychodermatology input, costing £218 (€242), helped her to identify that her predominant problem was with her mental health and she agreed to psychiatric referral. This resulted in marked improvement in both her skin and other symptoms, including regaining of some of her vision, allowing her to be discharged to psychiatric services. Patient C presented with painful, non-healing ero- sions which he attributed to tick bites. He had amassed an extensive collection of samples and had consulted a number of clinics around the region. He was diagno- sed with delusional infestation and was referred to the psychodermatology clinic where he has been started on risperidone. The cost of his care prior to referral was £2,892 (€3,223). Within the psychodermatology service, his care has so far cost £464 (€517) and he is now making good progress. As he is likely to be within the service for more than a year, we can compare annual costs for this patient. Prior to referral his care cost £1,928 (€2,148) per annum, and within psychodermatology it is projected to cost £546 (€608) per annum. This is a cost-saving of £1,382 (€1,540, 72%) per annum. Finally, patient D presented with a 7-year history of intractable eczema on her pinnae. She was about to com- mence ciclosporin when, after admitting to extensive scratching, she was referred to the psychodermatology clinic. Habit reversal therapy was introduced which led to a resolution of her eczema and she was discharged. METHODS We aimed to study the direct healthcare costs associated with caring for 4 typical patients with a range of diagnoses in our psychodermatology service. We used nationally-agreed tariffs to estimate the costs of primary and secondary care consultations, investigations and treatments prior to referral, and compared this to the costs incurred within the psychodermatology service (Table I). At the time that the patients were cared for, our service comprised a consultant dermatologist conducting joint patient assessments with a senior clinical psychologist. Limited in-house psychological therapy was available thereafter if indicated, but we had to refer on to separate local psychiatric services if this was deemed necessary. RESULTS Patient A presented with episodic hair loss and was even- tually diagnosed with trichotillomania. Prior to referral, her care was estimated to have cost £1,209 (€1,347). She was assessed in the psychodermatology service and received a short course of psychological therapy, costing £386 (€430) in total. This led to acceptance of her hair- pulling and resulted in resolution of her symptoms. Patient B was referred to dermatology with multiple large bullae and erosions. She also reported a myriad of Table I. Summary of healthcare-related costs in 4 typical patients with psychocutaneous problems A B C D 3 3 3 0 0 1 1 0 5 £1,209 (€1,347) £386 (€430) 14 1 2 0 2 2 1 1 0 £5,555 (€6,190) £218 (€242) (+psychiatry costs) 5 4 9 2 4 2 1 4 0 £2,892 (€3,223) £464 (€517) 0 3 6 0 67 0 1 3 0 £9,222 (€10,277) £382 (€425) Trichotillomania General practitioner appointments Dermatology – new outpatient appointment Dermatology – follow-up outpatient appointment A&E attendance Other specialty outpatient appointment Biopsies Psychodermatology – new outpatient appointment Psychodermatology – follow-up outpatient appointment Psychology sessions Cost before Cost after Factitious skin disease This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica. Delusional infestation Habitual scratching doi: 10.2340/00015555-2620 Acta Derm Venereol 2017; 97: 663–664