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Margaret Byrne, Byron Lam, Dorothy Parker, Manuel Ocasio, Jenelle Lin, David Lee; Cost of a Community-Based Diabetic Retinopathy Screening Program. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1543.
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To assess the costs associated with a community-based program to screen adults for diabetic retinopathy.
As part of a multi-center national research initiative, vision screening for diabetics was offered at a community health center in a low socioeconomic area of Miami-Dade County. A non-mydriatic fundus camera was used to screen for diabetic retinopathy. Visual acuity was also tested. Fundus photos were transmitted electronically to and graded at a remote reading center. Referrals for clinical care were made when needed. Data were collected on start-up costs, such as equipment, and on continuing costs, including personnel, fees for reading retinal scans, and supplies. Costs associated with research were not included. Total costs, cost per person screened and per referral were calculated. Start-up costs were distributed over the total number of individuals planned to be screened (500) and per referral, for a conservative assessment of total cost per screening and referral. For sensitivity analyses, we assumed a 3 and 5 year life-span for equipment and recalculated cost per screening and referral.
In the first 9 months, 477 adults were screened. This included 210 (44%) blacks, 260 (55%), Hispanics, 306 (64%) women, and 73 (15%) current smokers. The average age of participants was 55.8 years (sd 9.5) and average time since a diabetes diagnosis of 9.6 years (sd 8.3). 79% had no health insurance, 44% had not had an eye exam in the last 2 years, and 10% had never had an eye exam. Referrals were made for 121 abnormal scans. The table shows start-up and continuing costs, and continuing costs per scan and per referral. Total cost of the intervention to date is $85,714. Distributing all start-up costs among the 477 participants, cost per screening was $177 and the cost per patient referred was $708. With the less conservative assumption that the camera and equipment will last 3 years, the estimated cost per screening was $135 and cost per problem detected was $531; with a 5 year assumption, estimates were $129 and $507 respectively.
Among the participants screened, the majority did not have health insurance, many had not had a recent eye exam, and follow-up referrals were needed for 25%, demonstrating the need for this type of screening program. The relatively low cost of the program, particularly per referral, illustrates that such a community-based screening intervention could be widely adopted.
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