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Alfonso Anton-Lopez, Monica A. Fallon, Francesc Cots, Enric Duran-Tauleria, Maria Angeles Sebastian, Antonio Morilla-Grasa, Xavier Castells; Cost-Effectiveness Analysis of a Telemedicine Program for the Detection of Glaucoma with Imaging Devices. Invest. Ophthalmol. Vis. Sci. 2011;52(14):251.
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Analysis of cost/effectiveness of a telemedicine program for the detection of glaucoma.
Cross-sectional study design. Two detection methods were compared in a population-based random sample of 1599 subjects: 1) Opportunistic detection at the primary care center, named as "usual care" and 2)"Screening by telemedicine". The usual care detection method was evaluated by analyzing data from primary care center. The telemedicine screening program was assessed in the same sample and aimed to population at risk the following year. During the telemedicine program 414 subjects were examined with Heidelberg Retina Tomograph, Nerve Fiber Analyzer (GDX-VCC), and rebound tonometry (Icare). All subjects with at least 2 of the 3 following criteria were considered suspects and referred to a glaucoma consultation: global Moorfields Regression Analysis borderline or outside normal limits, Nerve Fiber Index ≥30, and tonometry ≥ 21mmHg. At glaucoma consultation patients were classified as non-glaucoma, probable glaucoma or glaucoma. The cost of diagnosis was assessed by adding the costs of personal, infrastructure and instruments implicated in the diagnostic process. Cost/effectiveness of both detection methods was compared.
Usual care identified and examined 165 subjects, from those only 2 were finally diagnosed of probable glaucoma. Telemedicine screening examined 414 subjects, 32 were referred to glaucoma consultation, 8 were diagnosed of glaucoma and 9 as probable glaucoma. Detection rate was 4.1% for telemedicine screening, 1.2% for usual care in the sample selected and 3.1% for usual care in the population. The health care cost was estimated as follows: primary care visit=15€; general ophthalmic visit=18€, ophthalmic visit with tests=52€, telemedicine screening=51€, and glaucoma consultation=126€. The cost of the telemedicine program was 24,150€, and the cost of usual care in the sample was 8,798€. The cost per case detected was 1420€ in the telemedicine screening and 1759€ to 4399€ by usual care.
The telemedicine program offered a detection rate of 4.1%. An incremental cost of 24,150€ allowed the detection of 8 cases with glaucoma and 9 cases with probable glaucoma. Population-based glaucoma screening programs may be cost-effective.
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