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Maram Isaac, Wanrudee Isaranuwatchai, Nasrin Najm Tehrani; Cost Analysis of Telemedicine Screening for Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6263.
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© ARVO (1962-2015); The Authors (2016-present)
To compare costs and clinical outcomes of two screening modalities for retinopathy of prematurity (ROP) from a rural area in Ontario, Canada: telemedicine screening using wide field digital imaging performed by non-ophthalmic personnel versus inter-hospital transfer for in-person indirect ophthalmoscopy (BIO).
We conducted cost analysis from the perspective of the Ministry of Health using retrospective data (2009-2014) from an existing telemedicine screening program. Follow up imaging and referral indications were according to current clinical screening guidelines. Referral was required for type 2 ROP or worse. All infants had final BIO examination by an ophthalmologist after discharge from NICU. Data on severity of ROP at each examination and at final in person exam was collected. Patient level data on costs was used for infants screened via telemedicine. We created a hypothetical control group that comprised of minimum number of in-person visits and inter-hospital transfers if the existing patients were screened by BIO. In total, costs consisted of cost of in-person exams, transfers, setting up and ongoing costs of telemedicine screening. Cost variables were compared using the Mann-Whitney U test.
102 infants were screened via telemedicine. A total of 223 telemedicine exams were performed. 34 infants were diagnosed with ROP. No cases of type 2 ROP were missed. 3 infants required laser treatment. Only 4 infants (3%) needed at least one transfer in the telemedicine group and 106 infants (90%) in the control group. Average total cost per examination was $4,855±$515 (2014 Canadian dollars) for the telemedicine group and $19,834±13,814 for the control group (p<0.001). The main cost for the control group was inter-hospital transfer cost ($19,489±$13,605) compared to ($635±$3,968) for the telemedicine group (p<0.001).
Telemedicine appears to be a viable alternative for remote areas where access to ROP screening service is suboptimal. The telemedicine group reported significantly lower average total cost per visit compared to the hypothetical control group. Inter-hospital transfer was the main contributing cost. This information will be useful for planning similar ROP services for remote areas.
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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