Candidate for the Lee B. Lusted Student Prize Competition
Purpose: To determine the incremental cost-effectiveness of telemedicine based diabetic retinopathy detection (DRD) program compared with referring patients to an eye doctor for a standard dilated eye examination to meet the annual retinal examination metric for diabetic patients who belong to the migrant farm worker population and visit a primary care provider.
Method: Deterministic decision tree cost-effective analysis was performed using Tree Age Software. Primary data from a pilot primary care based teleophthalmology program for migrant farm workers in Sodus, NY health data, published epidemiologic data for diabetic retinopathy related incidence, prevalence and vision loss in the Latino population and general populations, and data from studies on the effectiveness of retinal photographs to detect vision threatening retinopathy were used to determine and populate values for tree probabilities. Published utility data on visual function for diabetic patients and cost of care for diabetic retinopathy from the pilot Sodus program and from the billing office of the Flaum Eye Institute, University of Rochester, were used to derive inputs for effectiveness and cost in the model. A deterministic sensitivity analysis was performed on key variables to account for input variability in the model.
Result: Cost-effective ratios of the teleophthalmology DRD program and conventional referral to general eye doctor for a dilated exam were $1566.52 and $2729.08 respectively, with an incremental cost-effectiveness ratio of $15,903.56 per QALY gained.
Conclusion: Both teleophthalmology and referral to a general eye doctor were found to be cost effective strategies for detecting vision threatening retinopathy and preventing vision loss in the migrant farm worker population, with teleophthalmology being slightly more cost effective. Additional epidemiological, visual function, and economic data from the other 166 health centers serving this unique and vulnerable population across the U.S. would enable application of this analysis to migrant farm worker health programs throughout the country.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making