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Arthur Clifton Guyton, April Yauguang Maa, Barbara Wojciechowski, Clara Libby Dismuke, Kelly Hunt, Ashley Howell; Cost Analysis of a Novel Comprehensive Tele-ophthalmology Program in VA Primary Care Clinics. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5483.
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© ARVO (1962-2015); The Authors (2016-present)
The cost of telemedicine as it relates to eye care is known for models of limited scope, such as screening for diabetic retinopathy, but as the capabilities of telemedicine have grown in recent years, the cost of more comprehensive teleophthalmology care models is unknown as of now. Data from the VA was used in a quality improvement project to compare the cost of teleophthalmology to the cost of in-person exams.
Cost data was collected from the Health Economics Research Center (HERC) database for both in-person comprehensive new exams and for teleophthalmology screening exams performed using the Technology-based Eye Care Services (TECS) protocol. All patients examined in fiscal years 2016 and 2017 (10/1/15 - 9/30/17) were included in the analysis, yielding 6,777 patients for the teleophthalmology cohort and 7,256 patients for the in-person exam cohort. The mean annual costs of eye care for the teleophthalmology group and for the traditional in-person exam group were compared using t-tests. Direct and indirect costs were separated to show the overhead costs allocated to each patient.
The mean annual cost of eye care for patients seen through teleophthalmology was found to be $363.00, while that of patients seen through traditional in-person exams was found to be $382.60, showing an average savings of $19.60 (p<0.01) annually per patient. For patients diagnosed with AMD, the direct and indirect costs for the TECS program are $280.40 and $189.80, compared to $384.20 and $259.60 for in-person exams (p<0.05). For patients with diabetic retinopathy, the direct and indirect costs for the TECS program are $293.10 and $197.00, compared to $387.30 and $261.30 for in-person exams (p<0.05). For patients with cataracts, the direct and indirect costs for TECS are $242.90 and $162.70, compared to $245.90 and $165.20 for in-person exams (p>0.05). For glaucoma, the direct and indirect costs for TECS are $298.70 and $199.80, compared to $342.80 and $230.60 for in-person exams (p<0.01).
Teleophthalmology through the TECS program reduces the cost of patient care when compared with in-person exams. Teleophthalmology is shown to be useful for saving on costs for new comprehensive exams as part of a population health management strategy. As the volume of patients increases for the TECS program, the indirect costs will become even lower as the overhead will be spread over more patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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