An economic analysis of screening for diabetic retinopathy

Abstract

The costs of telemedicine screening for diabetic retinopathy were examined in a trial conducted in northern Norway, involving the University Hospital of Tromsø (UHT) and the primary care centre in Alta, approximately 400 km away. In Alta, specially trained nurses examined 42 diabetic patients using a digital camera to obtain images of the retina. The images were then sent by email to an eye specialist at the UHT. A cost-minimization analysis showed that at low workloads, for example 20 patients per annum, telemedicine was more expensive than conventional examination: NKr8555 versus NKr428 per patient. However, at higher workloads, telemedicine was cheaper. For example, at 200 patients per annum, telemedicine cost NKr971 and conventional examination cost NKr1440 per patient. The break-even point occurred at a patient workload of 110 per annum. Given that there are some 250 diabetic patients in Alta, telemedicine screening is the cheaper service for the public sector.

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey

“…Teleophthalmology aims to increase accessibility to screening while reducing costs. A Norwegian study examined the costs of telemedicine screening for DR 825 . Specially trained nurses performed nonmydriatic digital retinal photography on 42 diabetic patients, and these images were then sent to an eye specialist.…”

A classification model for predicting eye disease in newly diagnosed people with type 2 diabetes

“…al. [11] estimated that the conventional screening costs would be between 56 $ (335 NKr) and 459 $ (2730 NKr), depending on number of patients. If the number of patients exceeds the screening capacity of the nearby hospitals, such costs will increase considerably.…”

“…In Queensland, Australia, the results from a regional survey reported that only one in three young patients with diabetes had seen an ophthalmologist in the preceding 12 months [9]. It has been suggested to use telemedicine screening in these remote areas [9][10][11][12]. A cost-effectiveness analysis from the northern part of Norway showed that the telemedicine approach was more expensive than the conventional approach when operated at a small scale, but would break even in terms of costs per patient if a minimum of 110 patients were screened [11].…”

Results of Implementation of the DigiScope for Diabetic Retinopathy Assessment in the Primary Care Environment

“…Also, implementation of most currently available telemedicine imaging systems is practically and financially difficult in the primary care setting where few patients with diabetes requiring assessment for retinopathy are evaluated on any given day. 12 A new, validated diabetic retinopathy assessment system, involving placement of a semiautomated fundus camera in the primary care environment, was designed to facilitate referral of patients with diabetic retinopathy. It is based on the DigiScope (EyeTel Imaging, Inc., Columbia, MD), 13 which is operated by existing staff in the PCP's office, to acquire digital fundus images of patients with diabetes.…”