Cost-effectiveness of alternative methods for diabetic retinopathy screening
| Autor: | James M. Jacobson, David R. Lairson, Jacqueline A. Pugh, Asha S. Kapadia, Ronald J. Lorimor, Ramon Velez |
|---|---|
| Rok vydání: | 1992 |
| Předmět: |
Research design
genetic structures Cost effectiveness Endocrinology Diabetes and Metabolism Cost-Benefit Analysis Direct Ophthalmoscopy Internal Medicine medicine Pupillary response Ethnicity Humans Mass Screening Fluorescein Angiography Advanced and Specialized Nursing Diabetic Retinopathy medicine.diagnostic_test business.industry Technician Fundus photography Diabetic retinopathy Middle Aged medicine.disease eye diseases United States Socioeconomic Factors Optometry business Retinopathy |
| Zdroj: | Diabetes care. 15(10) |
| ISSN: | 0149-5992 |
| Popis: | OBJECTIVE To assess from the perspectives of a government delivery system and patients, the cost-effectiveness of the 45-degrees 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-degrees 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-degrees photos with dilation, $295; 45-degrees photos without dilation, $378; ophthalmologist, $390; and technician, $794. Patient costs per true positive were: 45-degrees photos with dilation, $139; 45-degrees 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|