Cost-effectiveness of alternative methods for diabetic retinopathy screening

D. R. Lairson, J. A. Pugh, A. S. Kapadia, R. J. Lorimor, J. Jacobson, R. Velez

Research output: Contribution to journalArticle

58 Scopus citations

Abstract

OBJECTIVE - To assess from the perspectives of a government delivery system and patients, the cost-effectiveness of the 45-degree retinal camera compared to the standard ophthalmologist's exam and an ophthalmic exam by a physician's assistant or nurse practitioner technician, for detecting nonproliferative and proliferative diabetic retinopathy. RESEARCH DESIGN AND METHODS - Comparison of 45-degree fundus photographs with and without pharmacological pupil dilation taken by technicians and interpreted by experts, direct and indirect ophthalmoscopy by ophthalmologists, and direct ophthalmoscopy by technicians with seven-field stereoscopic fundus photography (reference standard). Costs were estimated from market prices and actual resource use. The study included 352 patients attending outpatient diabetes and general-medicine clinics at VA and DOD facilities. RESULTS - Medical system costs per true positive were: 45-degree photos with dilation, $295; 45-degree photos without dilation, $378; ophthalmologist, $390; and technician, $794. Patient costs per true positive were: 45-degree photos with dilation, $139; 45-degree photos without dilation, $171; ophthalmologist, $306; and technician, $1009. Cost-effectiveness is sensitive to program size due to high fixed cost of the camera methods but not to prevalence. Cost- effectiveness of the technician exam is strongly affected by its sensitivity. CONCLUSIONS - Primary-care screening with retinal photographs through pharmacologically dilated pupils for diabetic retinopathy is an appropriate and cost-effective alternative to screening by an ophthalmologist in this setting. Ophthalmologists are scarce, primary-care physicians are extremely busy, and large clinics allow fixed equipment costs to be spread across many patients.

Original languageEnglish (US)
Pages (from-to)1369-1377
Number of pages9
JournalDiabetes care
Volume15
Issue number10
DOIs
Publication statusPublished - Jan 1 1992

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ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Lairson, D. R., Pugh, J. A., Kapadia, A. S., Lorimor, R. J., Jacobson, J., & Velez, R. (1992). Cost-effectiveness of alternative methods for diabetic retinopathy screening. Diabetes care, 15(10), 1369-1377. https://doi.org/10.2337/diacare.15.10.1369