Cost-effectiveness of diabetic retinopathy screening programs using telemedicine: a systematic review

Abstract

Background: Diabetic retinopathy (DR) is a significant global public health and economic burden. DR accounts for approximately 15-17% of all cases of total blindness in the USA and Europe. Telemedicine is a new intervention for DR screening, however, there is not enough evidence to support its cost-effectiveness. The aim of this study is to review the most recent published literature on economic evaluations of telemedicine in DR screening and summarize the evidence on the cost-effectiveness of this technology. Methods:A systematic search of PubMed, Embase and Google Scholar for relevant articles published between January 2010 and January 2020. Studies were included if they met the following criteria: (1) recruited subjects with either type 1, type 2 diabetes (2) evaluated telemedicine technology (3) patients underwent primary screening for DR (4) compared a telemedicine-based intervention with standard care (5) performed an economic evaluation or provided sufficient data for evaluating the cost-effectiveness of the technology used.Results: Of 2238 articles screened, seven studies were included. Four of the studies were conducted in developed countries: The United States, Singapore and two studies in Canada. Three studies were conducted in developing countries: India, Brazil and South Africa. The patient populations in all studies were diabetic patients over the age of 18, previously not screened for DR. All seven studies used a telemedicine program which included capturing a retinal image and subsequently transmitting it to an ocular imaging center to assess the severity of DR. All studies compared telemedicine to a standard screening method for DR, including the option of no screening as standard of care. Although telemedicine requires initial and maintenance costs, it has the potential to provide significant cost savings by increasing patients' working ability, increasing independent living ability, increasing quality of life and reducing travel costs. Conclusions:Diabetic retinopathy telemedicine technology has the potential to provide significant cost savings, especially in low-income populations and rural patients with high transportation costs.

The Importance of Telemedicine during COVID-19 Pandemic: A Focus on Diabetic Retinopathy

“…Lack of time, distance from specialized centers, disabilities, and long waiting lists are among the most common causes of a limited access of patients to specialty visits. In the case of pandemics, social distancing further contributes [ 31 – 35 ].…”

“…Moreover, teleophthalmology disclosed a good cost-to-efficacy ratio, both in terms of human and monetary resources, and travelling costs for patients and public health systems [ 59 ]. It has been recently demonstrated, in a meta-analysis focused on cost efficacy assessment of ophthalmologic screening programs by telemedicine in several countries (e.g., the United States, Canada, Singapore, India, Brazil, and South Africa), that, though with an initial increase of costs related to devices and training, over time, there is an economic saving [ 31 ]. Likewise, in our multicenter experience, remarkable monetary savings from the use of retinal cameras rather than traditional exam (estimated mean cost per patient equal to €3.02 vs. €7.75) were observed, as well as time savings both for patients and clinicians (about 2/3 minutes vs. 20/30 minutes) [ 50 ].…”

More room for telemedicine after COVID-19: lessons for primary care?

“…Several studies have shown that TM is not inferior to traditional consultations in terms of clinical efficacy and quality of life, especially for chronic diseases which require periodic check-ups [18][19][20][21][22]. The most paradigmatic example is diabetes-probably not by chance the very first pathology to which the concept of patient empowerment was applied [23]-due to the crucial importance of lifestyle and thus the major role played by patients in the management of their own health.…”

Importance of the Use of Oxidative Stress Biomarkers and Inflammatory Profile in Aqueous and Vitreous Humor in Diabetic Retinopathy

“…Furthermore, it is estimated that~191 million people will be diagnosed with this microvascular complication by 2030 [8,9], and the number of DR patients whose vision is threatened will increase from 37.3 to 56.3 million. This disturbing prospect makes the DR a significant global public health and economic problem [10].…”