Cost-effectiveness of app-based teleconsultation between professionals versus in-person care for the diagnosis of malignant and potentially malignant oral lesions in the Brazilian Unified Health System

Abstract

Oral cavity cancer represents a major public health challenge, particularly in low- and middle-income countries, where access to specialized diagnostic services is often limited. Early diagnosis is associated with improved clinical outcomes and reduced treatment burden. This study evaluated the cost-effectiveness of an app-based teleconsultation between primary care dentists and oral medicine specialists compared with conventional in-person referral for the diagnosis of malignant and potentially malignant oral lesions within the Brazilian Unified Health System (SUS). A cost-effectiveness analysis was conducted using a decision tree integrated with a Markov model to simulate a hypothetical cohort of 1,000 individuals aged 40 years and older. The analysis was performed from the SUS perspective over a lifetime horizon, incorporating both the diagnostic phase and long-term disease progression. Costs were estimated in Brazilian reais (R$), and health outcomes were expressed in quality-adjusted life years (QALYs). Model inputs were obtained from Brazilian official databases and published literature. Deterministic and probabilistic sensitivity analyses were performed to evaluate parameter uncertainty. The app-based teleconsultation between professionals’ strategy was associated with lower costs and slightly higher effectiveness compared with conventional in-person care. Per patient, the teleconsultation strategy resulted in cost savings of R$128.36 and an incremental gain of 0.0011 QALYs, remaining economically dominant over the comparator. The sensitivity of the conventional in-person examination was the parameter with the greatest influence on model outcomes. Probabilistic sensitivity analysis demonstrated that the teleconsultation strategy was dominant in 96% of the 1,000 Monte Carlo simulations, consistently showing lower costs and marginally greater effectiveness. Although the incremental QALY gain was modest, the strategy demonstrated potential to reduce diagnostic delays and optimize resource allocation within the SUS. App-based teleconsultation between primary care dentists and specialists may represent a cost-saving and scalable strategy for improving access to oral cancer diagnosis in the Brazilian public health system. Despite the small incremental effectiveness gain, the strategy consistently reduced costs while maintaining slightly better health outcomes compared with conventional referral pathways. DOI: https://doi.org/10.17605/OSF.IO/TD5XC .

The authors' abstract, as published at the source. BMC Health Services Research, 2026 · DOI ↗