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K. M. Jackson, K. Scott, J. Graff Zivin, D. Bateman, J. T. Flynn, M. F. Chiang; Cost Benefit Analysis of Telemedicine for Retinopathy of Prematurity Diagnosis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3106.
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Retinopathy of Prematurity (ROP) is a leading cause of blindness in premature infants, and is currently diagnosed from dilated ophthalmoscopy by an experienced ophthalmologist. This current system is time-intensive, disruptive, physiologically stressful for infants, and limited by decreasing availability of ophthalmologists trained in ROP. Telemedicine has potential to improve the quality, accessibility, and cost of ROP care. However, the long-term viability of telemedicine for ROP will likely depend on economic factors and cost-benefit tradeoffs, which are not well-understood. This study seeks to evaluate the cost-effectiveness of a telemedicine system for ROP diagnosis, compared to standard dilated fundus examination (DFE) by an ophthalmologist.
A decision tree was used to model two competing strategies: (1) standard serial DFE by an ophthalmologist, and (2) a telemedicine system in which serial fundus photography is performed using a commercially-available wide-angle retinal camera, and images felt to represent type-2 or worse ROP are referred for subsequent DFE by an ophthalmologist. Cost data for ROP examination and treatments were from a third-party payer perspective, based on 2005 Medicare charges. Data regarding performance of the telemedicine system were taken from published findings, and visual outcome data were obtained from major published ROP studies and converted to utility values. Present value analysis was applied with a 3% discount rate. Outcomes were compared based on cost per quality-adjusted life year ($/QALY) based on an average life expectance of 78 years. Sensitivity analysis was performed.
A telemedicine system for ROP diagnosis is more cost-effective ($3,012/QALY) than standard DFE by an ophthalmologist ($14,151/QALY). Sensitivity analysis on the discount rate (0%-6%), percentage of readable photos (70%-100%), and positive predictive value of telemedicine examination (50%-100%) maintains the telemedicine system more cost-effective.
Telemedicine has potential to be a cost-effective approach for ROP examination, based on an analysis that incorporates both medical cost and visual outcome data.
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