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Shwetha Mangalesh, Anand Vinekar, Suhruta Kulkarni, Shainesh G, Chaitra Jayadev, Noel Bauer, Bhujang Shetty; Estimating the cost of ROP treatment and services: A mathematical Model. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):946.
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© ARVO (1962-2015); The Authors (2016-present)
Retinopathy of Prematurity (ROP) screening services are sub-optimal in middle-income countries. Although considered essential neonatal care, the cost of screening and treatment services remain un-estimated, leading to lack of insurance coverage, poor specialist compensation and potential financial exploitation. We report a practical, ‘real-life’, financial calculator to assess these costs based on pragmatic case-load scenarios, customizable to the settings of the operators.
We used the financial, balance sheets from seven financial years of the Karnataka Internet assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program. KIDROP provides ROP screening in 90 neonatal units serving a population of 60 million in four zones using wide-field digital imaging (Retcam Shuttle, Clarity MSI, USA) and a tele-medicine platform in India. Financial inputs included capital and operational costs. Operational expenditure and revenue were estimated. Depreciation, loan repayment, interest, inflation and amortization values were ascertained. Provision for free or subsidized service was included. Break-even costs and profit margins were customized. An Excel based (Microsoft Inc, USA) calculator was generated.
This financial calculator was validated using KIDROP data. Operational settings included a dedicated ROP team, a single pediatric retinal specialist, subsidy in 30% and free of cost in 15% of screening sessions and treatment with 532 nm green laser. In our setting with an annual case-load of approximately 12,000 screening sessions and 200 laser treatments, the cost per screening is USD 4.04 and laser treatment in both eyes is USD 242 using this computation.
This financial calculator is customizable for any setting to estimate the cost of providing ROP screening and treatment services. Conversely, if the costs and return on investment are known, the ‘break-even’ number of cases required for financial viability can be estimated. This fiscal knowledge will allow objective estimation of health care expenditure assessment, insurance coverage and appropriate physician compensation. Cost-utility estimation would encourage more physicians and organizations to plan expenditure in providing ROP screening
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