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J. Flynn, J.D. Keenan, J.S. Graff Zivin; Cost-effectiveness of the RetCam 120 in Screening for Retinopathy of Prematurity . Invest. Ophthalmol. Vis. Sci. 2003;44(13):587.
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Purpose: Retinopathy of Prematurity (ROP) is a disease of low birth weight infants that causes significant ocular morbidity. Because there is an effective treatment for ROP, it is important to screen at-risk infants for the disease. Infants are currently screened by individual ophthalmologic exams. Recently, a digital retinal camera known as the RetCam 120 has been studied as a tool for ROP screening. Because non-ophthalmologists could conduct RetCam exams, RetCam might have lower labor costs and be cost-saving. However, because the RetCam has a lower test sensitivity than ophthalmologic exam1, the RetCam might result in more false negative results, rendering it a less effective test than ophthalmologic exam. It is thus unclear if a RetCam screening approach would be as cost-effective as ophthalmologic exams only. This study compares the cost-effectiveness of the RetCam with the current standard of serial ophthalmologic exams. Methods: A decision tree analysis for ROP detection and treatment was performed comparing serial ophthalmologic exams versus a RetCam approach, in which only infants testing positive to at least one of two initial RetCam exams went on to receive ophthalmologic exams. Costs and effects were estimated using data from previous clinical trials, and results were reported in cost per case of blindness prevented. Results: Ophthalmologic exam cost $15,054 per case of blindness prevented, whereas RetCam cost $15,922 per case of blindness prevented. Sensitivity analyses revealed that the RetCam would become more cost-effective than ophthalmologic exam if the cost of the RetCam camera were decreased by one-fourth, or if the RetCam sensitivity were increased to 98%. Conclusion: The ophthalmologic exam approach is more cost effective than the RetCam approach. However, at a lower RetCam camera cost and higher RetCam test sensitivity, the RetCam approach could be more cost-effective than ophthalmologic exams only. 1. Roth DB, D Morales, WJ Feuer, D Hesse, RA Johnson, JT Flynn. Screening for retinopathy of prematurity employing the RetCam 120: sensitivity and specificity. Archives of Ophthalmology 2001; 119:268-272.
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