Tele-retina screening of diabetic retinopathy among at-risk populations: an economic analysis

Stanimirovic, Aleksandra; Francis, Troy; Shahid, Nida; Sutakovic, Olivera; Merritt, Rebecca; Brent, Michael H.; Rac, Valeria E.

doi:10.1016/j.jcjo.2019.06.008

Cited by 21 publications

(12 citation statements)

References 8 publications

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“…The systematic teleophthalmology based screening was more effective although more expensive: an additional cost of $209 and incremental QALY of 0.042; thus the ICER of this intervention was $4976/QALY, which is under the ICER threshold ($14,953/QALY). Stanimirovic et al [27] assessed the cost-effectiveness of a pilot Toronto teleophthalmology screening program using a decision tree model. Images were taken by the primary care provider and analyzed by a retina specialist.…”

Section: Resultsmentioning

confidence: 99%

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

Avidor

Loewenstein

Waisbourd

et al. 2020

Cost Eff Resour Alloc

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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.

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Section: Resultsmentioning

confidence: 99%

“…Ben et al [26] presented that systematic teleophthalmology based screening is cost-effective compared to opportunistic ophthalmology-referral based screening in Brazil. Stanimirovic et al [27] found that teleophthalmology screening dominated the standard of care in a Canadian pilot study (ICER < 0).…”

Section: Discussionmentioning

confidence: 99%

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

Avidor

Loewenstein

Waisbourd

et al. 2020

Cost Eff Resour Alloc

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“…This strategy is driven by the recognition that access to optometrists and ophthalmologists is difficult for individuals with diabetes who live in certain neighborhoods in Toronto. [31]. In 2019, findings from a cost-effectiveness study suggested that tele-retina is a more cost-effective means of screening for diabetic retinopathy than the standard of care screening in urban and rural underscreened communities, and this study represents a natural progression of the previous collaborative work.…”

Section: Program Descriptionmentioning

confidence: 82%

Impact of Intersecting Systems of Oppression on Diabetic Retinopathy Screening Among Those Who Identify as Women of Low Socioeconomic Status: Protocol for a Convergent Mixed Methods Study

et al. 2021

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Background By 2025, 5 million Canadians will be diagnosed with diabetes, and women from lower socioeconomic groups will likely account for most new diagnoses. Diabetic retinopathy is a primary vision complication of diabetes and a leading cause of blindness among adults, with 26% prevalence among women. Tele-retina is a branch of telemedicine that delivers eye care remotely. Screening for diabetic retinopathy has great potential to reduce the incidence of blindness, yet there is an adverse association among screening, income, and gender. Objective We aim to explore gender disparity in the provision of tele-retina program services for diabetic retinopathy screening in a cohort of women of low socioeconomic status (SES) receiving services in South Riverdale Community Health Centre (SRCHC) between 2014 and 2019. Methods Using a convergent mixed methods design, we want to understand patients’, providers’, administrators’, and decision makers’ perceptions of the facilitators and barriers associated with the implementation and adoption of tele-retina. Multivariate logistic regression will be utilized to assess the association among client characteristics, referral source, and diabetic retinopathy screening. Guided by a grounded theory approach, systematic coding of data and thematic analysis will be utilized to identify key facilitators and barriers to the implementation and adoption of tele-retina. Results For the quantitative component, we anticipate a cohort of 2500 patients, and we expect to collect data on the overall patterns of tele-retina program use, including descriptions of program utilization rates (such as data on received and completed diabetic retinopathy screening referrals) along the landscape of patient populations receiving these services. For the qualitative component, we plan to interview up to 21 patients and 14 providers, administrators, and decision makers, and to conduct up to 14 hours of observations alongside review of relevant documents. The interview guide is being developed in collaboration with our patient partners. Through the use of mixed methods research, the inquiry will be approached from different perspectives. Mixed methods will guide us in combining the rich subjective insights on complex realities from qualitative inquiry with the standard generalizable data that will be generated through quantitative research. The study is under review by the University Health Network Research Ethics Board (19-5628). We expect to begin recruitment in winter 2021. Conclusions In Ontario, the screening rate for diabetic retinopathy among low income groups remains below 65%. Understanding the facilitators and barriers to diabetic retinopathy screening may be a prerequisite in the development of a successful screening program. This study is the first Ontario study to focus on diabetic retinopathy screening practices in women of low SES, with the aim to improve their health outcomes and revolutionize access to quality care. International Registered Report Identifier (IRRID) PRR1-10.2196/23492

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“…When implemented in the primary care setting, telescreening for retinal diseases increased rates of evaluation among traditionally underserved communities [ 17 ]. Economically, such programs represent a significantly more efficient use of resources when compared to routine in-person visits [ 34 ]. Thus, as a modality of healthcare delivery, telemedicine provides the opportunity to substantially expand coverage of patients who would otherwise be underdiagnosed.…”

Section: Discussionmentioning

confidence: 99%

Telemedicine for Retinal Disease During the COVID-19 Pandemic: Survey of the Patient Perspective

Patel

Bhagat

et al. 2022

Ophthalmol Ther

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Introduction Amidst the COVID-19 pandemic, telemedicine has emerged as a safe and cost-effective alternative to traditional ophthalmology clinic visits. This study evaluated patient attitudes towards telemedicine at a full-service, retina-only practice to identify areas for growth in implementation. Methods A survey was distributed to established patients at University Retina and Macula Associates following the completion of a telemedicine encounter in July 2021. On a 5-point Likert scale, patients compared telemedicine to in-person visits for six domains: ability to ease COVID-related anxiety, efficiency, patient education, quality of care, fulfillment of personal needs, and convenience. Pearson’s χ 2 and Fisher’s exact test were used to assess correlations between demographic factors and patient attitudes or preference towards telemedicine. Results Among 103 respondents, two-thirds (68.7%) preferred in-person compared to telemedicine encounters. Overall, patients had a neutral attitude towards telemedicine [mean Likert rating (SD) = 3.11/5 ± 0.82]. Questions assessing “patient education” and “telemedicine efficiency” received the greatest proportion of positive and negative responses, respectively. Positive attitudes were more frequent among patients with prior telemedicine experience (87.5%) compared to never-users (71.8%; p = 0.046). Patients ≥ 75 years old tended to negatively assess telemedicine regarding reduction of COVID-19-related anxiety, efficiency, patient education, and physician facetime ( p < 0.05 for all). A positive but non-significant trend was observed between higher education level and positive attitude towards telemedicine ( p = 0.18). Telehealth never-users more often negatively rated receiving adequate facetime with the physician virtually (54.7%) compared to prior users (25.6%; p = 0.004). Younger age, prior history of telemedicine use, and higher education level were associated with increased preference for telemedicine ( p < 0.05 for all). Conclusion Our findings revealed hesitance remains among patients towards adoption of telemedicine. Targeting age-, experience-, and education-related barriers will be invaluable for increasing acceptance of this healthcare delivery model. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00555-2.

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Tele-retina screening of diabetic retinopathy among at-risk populations: an economic analysis

Cited by 21 publications

References 8 publications

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

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

Impact of Intersecting Systems of Oppression on Diabetic Retinopathy Screening Among Those Who Identify as Women of Low Socioeconomic Status: Protocol for a Convergent Mixed Methods Study

Telemedicine for Retinal Disease During the COVID-19 Pandemic: Survey of the Patient Perspective

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