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Robert B Garoon, Yvonne Chu, sunil gupta, Christina Y. Weng; Automated Teleretinal Screening for Diabetic Retinopathy in the Harris Health System: Cost Analysis & Economic Impact. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1585. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Although teleretinal screening for diabetic retinopathy is an effective method of increasing access to care, limited data exists on its cost effectiveness. We performed a retrospective chart review to explore the economic impact of a computer algorithm-based diabetic teleretinal screening program on the Harris Health System (HHS).
We analyzed 30,030 eyes of 15,015 consecutive patients over 1 year (2014-2015). All HHS patients with diabetes mellitus without a documented eye exam in the preceding year were screened via a non-mydriatic, auto-focus digital retinography system (DRS, CenterVue, Padova, Italy). The Intelligent Retinal Imaging System (IRIS, Pensacola, FL) integrated grading module referred patients for clinical exam if the image was consistent with severe nonproliferative diabetic retinopathy (DR) or proliferative DR; patients with milder DR were assigned to observation with re-imaging in one year. Patients were treated according to ETDRS guidelines. Direct medical costs of evaluation and treatment were calculated using an activity-based approach associated with the operational throughput of a patient who enters the screening program. Cost savings were estimated based on the 2015 Medicare fee schedule. The implicit assumption made was that had these patients not been screened, some would have presented with more severe disease. Probabilistic sensitivity analyses were performed.
The sensitivity of the automated screening program is 82.5% (95% confidence interval 80-85%) with a false negative rate of 1% in identifying severe nonproliferative DR or worse. The cost of each patient screened is approximately $55. The cost of a patient requiring panretinal photocoagulation is $1,354.67. The cost of a patient requiring pars plana vitrectomy with silicone oil tamponade is $2,854.94. Based on the 2015 Medicare fee schedule cost savings were found to be $150 per patient screened. This equates to a cost savings of over $4.5 million per year to HHS.
Automated teleretinal screening is a cost-effective method of screening large populations of diabetic patients. The HHS teleretinal screening protocol has generated cost savings by providing less costly interventions in earlier stages of diabetic retinopathy, leveraging technology to help identify those at imminent risk for blindness, and allowing better utilization of manpower to optimize patient care.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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