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Aoki N , Dunn K , Fukui T , Beck JR , Schull WJ , Li HK
Cost-effectiveness analysis of telemedicine to evaluate diabetic retinopathy in a prison population
Diabetes Care. 2004 May;27(5) :1095-1101
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Abstract
OBJECTIVE - A cost-effectiveness analysis was conducted to investigate the clinical and economic impact of teleophthalmology in evaluating diabetic retinopathy in prison inmated with type 2 diabetes. RESEARCH DESIGN AND METHODS - Based on a hypothetical teleophthalmology system to evaluate diabetic retinopathy patients with type 2 diabetes in a prison care setting, a Markov decision model was developed with probability and cost data derived primarily from published epidemiological and outcome studies. A 40-year-old African-American man with type 2 diabetes was used as a reference case subject. The number of quality-adjusted life-years (QALYs) gained was used as the clinical outcome, and the cost in U.S. dollars from the year 2003 was used as the economic outcome. Teleophthalmology and nonteleophthalmology strategies were compared using an expected QALYs calculation and two types of sensitivity analeyses: probabilistic and traditional n-way sensitivity analyses. RESULTS-The teleophthalmology strategy dominates in the cost-effectiveness analysis for the reference case subject: $16,514/18.73 QALYs for teleophthalmology and $17,590/18.58 QALYs for nonteleophthalmology. Ninety percent of the Monte Carlo simulations showed cost effectiveness (annual cost/QALYs less than or equal to $50,000) in the teleophthalmology strategy based on an assumed inmate population. Teleophthalmology is the better strategy if the number of diabetic inmates in the prison community is > 500. CONCLUSIONS- our cost-effectiveness analysis demonstrates that teleophthalmology holds great promise to reduce the cost of inmate care and reduce blindness caused by diabetic retinopathy in type 2 diabetic patients.
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English Article KeyWords Plus: MEDICAL DECISION-MAKING; CONVENIENT APPROXIMATION; FUNDUS PHOTOGRAPHY; LIFE EXPECTANCY; DISEASE PROFILE; OPHTHALMOSCOPY; EYE; PHOTOCOAGULATION; SENSITIVITY; INMATES Aoki, N; Univ Texas, Hlth Sci Ctr, Sch Hlth Informat Sci, 7000 Fannin,UCT-600, Houston, TX 77030 USA. Research Addresses: Univ Texas, Hlth Sci Ctr, Sch Hlth Informat Sci, Houston, TX 77030 USA. CHORD J, Tokyo, Japan. Schull Inst, Houston, TX USA. Kyoto Univ, Grad Sch Med, Dept Gen Med & Clin Epidemiol, Kyoto, Japan. *Fox* *Chase* Canc Ctr, Dept Informat Sci & Technol, Philadelphia, PA 19111 USA. Univ Texas, Med Branch, Dept Ophthalmol & Visual Sci, Galveston, TX 77555 USA. Cited References: *AM AC OPHTH QUAL, 1993, PREF PRACT PATT DIAB *NIH NAT I DIAB DI, 1995, DIAB AM ANNO B, 1997, HDB HLTH BEHAV RES AOKI N, 2001, MED DECIS MAKING, V21, P87 BAILLARGEON J, 2000, ANN EPIDEMIOL, V10, P74 BECK JR, 1982, AM J MED, V73, P883 BECK JR, 1982, AM J MED, V73, P889 BLANKENSHIP GW, 1991, OPHTHALMOLOGY, V98, P125 BROWN MM, 1999, AM J OPHTHALMOL, V128, P324 CHIANG YP, 1992, MILBANK Q, V70, P319 DAVIS MD, 1979, T AM OPHTHAL SOC, V77, P144 DOUBILET P, 1985, MED DECIS MAKING, V5, P157 FENDRICK AM, 1992, INT J TECHNOL ASSESS, V8, P694 FERRIS FL, 1993, JAMA-J AM MED ASSOC, V269, P1290 FRANKEL AE, 2002, PROTEIN PEPTIDE LETT, V9, P1 FROBERG DG, 1989, J CLIN EPIDEMIOL, V42, P345 GOLD MR, 1996, COST EFFECTIVENESS H JAVITT JC, 1994, DIABETES CARE, V17, P909 JAVITT JC, 1996, ANN INTERN MED 2, V124, P164 KLEIN R, 1985, OPHTHALMOLOGY, V92, P485 KLEIN R, 1989, ARCH INTERN MED, V149, P266 KNATTERUD GL, 1983, ISRAEL J MED SCI, V19, P424 LAMBERT M, 1996, ANN INTERN MED, V125, P939 LIN DY, 2002, AM J OPHTHALMOL, V134, P204 MOSS SE, 1998, OPHTHALMOLOGY, V105, P998 MOSS SE, 1985, OPHTHALMOLOGY, V92, P62 PASS TM, 1981, MED DECIS MAKING, V1, P465 PASTA DJ, 1999, MED DECIS MAKING, V19, P353 PETITTI DB, 2000, META ANAL DECISION A ROBERTSON JM, 2000, ANN EPIDEMIOL, V10, P71 SONNENBERG FA, 1993, MED DECIS MAKING, V13, P322 TORRANCE GW, 1989, INT J TECHNOL ASSESS, V5, P559 TORRANCE GW, 1987, J CHRON DIS, V40, P593 VANDER JF, 1991, OPHTHALMOLOGY, V98, P1575 VIJAN S, 2000, JAMA-J AM MED ASSOC, V283, P889 YOUNIS N, 2003, LANCET, V361, P195 Number of cited references: 36 Number of times cited: 0 Publisher: AMER DIABETES ASSOC; 1701 N BEAUREGARD ST, ALEXANDRIA, VA 22311-1717 USA. 0149-5992