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Ophthalmology. 2013 Mar;120(3):566-573. doi: 10.1016/j.ophtha.2012.09.002. Epub 2012 Dec 1.

The cost-utility of telemedicine to screen for diabetic retinopathy in India.

Author information

1
Department of Preventive Ophthalmology, Sankara Nethralaya, Vision Research Foundation, Chennai Tamil Nadu, India.
2
Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
3
International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
4
International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom; International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom. Electronic address: Hannah.Kuper@lshtm.ac.uk.
5
International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom; International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom.

Abstract

PURPOSE:

To assess the cost-effectiveness of a telemedicine diabetic retinopathy (DR) screening program in rural Southern India that conducts 1-off screening camps (i.e., screening offered once) in villages and to assess the incremental cost-effectiveness ratios of different screening intervals.

DESIGN:

A cost-utility analysis using a Markov model.

PARTICIPANTS:

A hypothetical cohort of 1000 rural diabetic patients aged 40 years who had not been previously screened for DR and who were followed over a 25-year period in Chennai, India.

METHODS:

We interviewed 249 people with diabetes using the time trade-off method to estimate utility values associated with DR. Patient and provider costs of telemedicine screening and hospital-based DR treatment were estimated through interviews with 100 diabetic patients, sampled when attending screening in rural camps (n = 50) or treatment at the base hospital in Chennai (n = 50), and with program and hospital managers. The sensitivity and specificity of the DR screening test were assessed in comparison with diagnosis using a gold standard method for 346 diabetic patients. Other model parameters were derived from the literature. A Markov model was developed in TreeAge Pro 2009 (TreeAge Software Inc, Williamstown, MA) using these data.

MAIN OUTCOME MEASURES:

Cost per quality-adjusted life-year (QALY) gained from the current teleophthalmology program of 1-off screening in comparison with no screening program and the cost-utility of this program at different screening intervals.

RESULTS:

By using the World Health Organization threshold of cost-effectiveness, the current rural teleophthalmology program was cost-effective ($1320 per QALY) compared with no screening from a health provider perspective. Screening intervals of up to a frequency of screening every 2 years also were cost-effective, but annual screening was not (>$3183 per QALY). From a societal perspective, telescreening up to a frequency of once every 5 years was cost-effective, but not more frequently.

CONCLUSIONS:

From a health provider perspective, a 1-off DR telescreening program is cost-effective compared with no screening in this rural Indian setting. Increasing the frequency of screening up to 2 years also is cost-effective. The results are dependent on the administrative costs of establishing and maintaining screening at regular intervals and on achieving sufficient coverage.

PMID:
23211635
DOI:
10.1016/j.ophtha.2012.09.002
[Indexed for MEDLINE]

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