June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Cost of a Community-Based Diabetic Retinopathy Screening Program
Author Affiliations & Notes
  • Margaret Byrne
    Epidemiology and Public Health, University of Miami, Miami, FL
    Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
  • Byron Lam
    Bascom Palmer Eye Institute, University of Miami, Miami, FL
  • Dorothy Parker
    Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
  • Manuel Ocasio
    Epidemiology and Public Health, University of Miami, Miami, FL
  • Jenelle Lin
    Epidemiology and Public Health, University of Miami, Miami, FL
  • David Lee
    Epidemiology and Public Health, University of Miami, Miami, FL
    Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
  • Footnotes
    Commercial Relationships Margaret Byrne, None; Byron Lam, None; Dorothy Parker, None; Manuel Ocasio, None; Jenelle Lin, None; David Lee, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 1543. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To assess the costs associated with a community-based program to screen adults for diabetic retinopathy.

 
Methods
 

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.

 
Results
 

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.

 
Conclusions
 

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.

  
Keywords: 499 diabetic retinopathy • 498 diabetes • 496 detection  
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