| Autor: |
Ortiz-Toquero S; IOBA Eye Institute, University of Valladolid, Valladolid, Spain.; Department of Theoretical Physics, Atomic and Optics, University of Valladolid, Valladolid, Spain., Aleixandre G; Department of Applied Economics, University of Valladolid, Valladolid, Spain., Valpuesta Y; Medina de Rioseco Healthcare Center, Salud Castilla y León, Medina de Rioseco, Spain., Perez Fernandez C; Department of Ophthalmology, University Clinic Hospital of Valladolid, Valladolid, Spain., de la Iglesia P; Regional Ministry of Health (Dirección General de Asistencia Sanitaria, Consejería de Sanidad), Valladolid, Spain., Pastor JC; IOBA Eye Institute, University of Valladolid, Valladolid, Spain.; Department of Ophthalmology, University Clinic Hospital of Valladolid, Valladolid, Spain.; RICORS (Thematic Network of the Carlos III, Institute of Health, Inflammation and immunopathology of organs and systems), Madrid, Spain., Lopez-Galvez M; IOBA Eye Institute, University of Valladolid, Valladolid, Spain.; Department of Ophthalmology, University Clinic Hospital of Valladolid, Valladolid, Spain. |
| Abstrakt: |
Objective: To determine the cost-effectiveness of a new telemedicine optometric-based screening program of diabetic retinopathy (DR) compared with traditional models' assessments in a universal European public health system. Methods: A new teleophthalmology program for DR based on the assessment of retinographies (3-field Joslin Vision Network by a certified optometrist and a reading center [IOBA-RC]) was designed. This program was first conducted in a rural area 40 km from the referral hospital (Medina de Rioseco, Valladolid, Spain). The cost-effectiveness was compared with telemedicine based on evaluations by primary care physicians and general ophthalmologists, and to face-to-face examinations conducted by ophthalmologists. A decision tree model was developed to simulate the cost-effectiveness of both models, considering public and private costs. The effectiveness was measured in terms of quality of life. Results: A total of 261 patients with type 2 diabetes were included (42 had significant DR and required specific surveillance by the RC; 219 were undiagnosed). The sensitivity and specificity of the detection of DR were 100% and 74.1%, respectively. The telemedicine-based DR optometric screening model demonstrated similar utility to models based on physicians and general ophthalmologists and traditional face-to-face evaluations (0.845) at a lower cost/patient (€51.23, €71.65, and €86.46, respectively). Conclusions: The telemedicine-based optometric screening program for DR in a RC demonstrated cost savings even in a developed country with a universal health care system. These results support the expansion of this kind of teleophthalmology program not only for screening but also for the follow-up of diabetic patients. |
