Tele-ophthalmology screening for proliferative diabetic retinopathy in urban primary care offices: An economic analysis

Christopher J. Brady, Andrea C. Villanti, Omesh P. Gupta, Mark G. Graham, Robert C. Sergott

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND AND OBJECTIVE: To determine whether tele-ophthalmology screening for proliferative diabetic retinopathy (PDR) can be cost-saving. PATIENTS AND METHODS: Adults with diabetes presenting for routine medical care underwent nonmydriatic fundus photography with remote grading. Direct medical costs were estimated using the Medicare fee schedule in the base case, with Medicaid and commercial insurance rates used for low and high values, respectively. One-way and probabilistic sensitivity analyses were performed. RESULTS: Of 99 participants, at least mild retinopathy was found in 24 (24.2%). Urgent consultation was recommended for eight participants (8.1%) for possible vision-threatening diabetic retinopathy, including two participants (three eyes) with PDR. In the base case, screening saved $36 per patient. A Monte Carlo simulation indicated that screening saved a median of $48 per patient. CONCLUSION: A substantial burden of diabetic retinopathy was identified, most of which was undiagnosed. In a closed system, tele-ophthalmology screening for PDR is likely to be cost-saving across the range of scenarios explored.

Original languageEnglish (US)
Pages (from-to)556-561
Number of pages6
JournalOphthalmic Surgery Lasers and Imaging Retina
Volume45
Issue number6
DOIs
StatePublished - Nov 1 2014

ASJC Scopus subject areas

  • Ophthalmology
  • Surgery
  • Medicine(all)

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