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Editors Selection IGR 17-1
Telemedicine: Cost-Effectiveness of a Screening Device
Comment by Kaweh Mansouri on:
Teleglaucoma is the application of electronic technologies to ophthalmic devices to remotely identify glaucoma patients. It is increasingly used as a triage tool for rural areas where patients are likely to have to travel greater distances to obtain an ophthalmology consultation.
Previous studies have demonstrated the feasibility of electronic stereoscopic fundus photograph analysis for glaucoma assessment1 and patient satisfaction with the related time and cost savings of teleglaucoma.2 Sensitivity and specificity of teleglaucoma has been reported to be at 86.5% and 78.6%, respectively.3
Thomas et al. conducted the first cost-effectiveness analysis of teleglaucoma, using data from rural populations of Alberta, Canada. Their study included patients at-risk of glaucoma over the age of 50. Markov modeling was used to model disease stages and cost-effectiveness ratio (ICER) for teleglaucoma was established. They found teleglaucoma to be more cost-effective than in-person care for detecting glaucoma, with an ICER of $46.7/QALY. This means that a spending of an additional $46.7 for each patient screened with teleglaucoma will give an additional QALY in comparison to in-person screeming.
For people who were initially screened positive, the Markov model gave a total reward of 15.7 QALYs over 30 years, 1.1 less than for in-person care. However, the cumulative costs for the latter were 3.5 times higher ($4035 vs. $1155). The direct financial benefits to patients was a cost saving of $2474 with teleglaucoma. Importantly, teleglaucoma enabled earlier detection of glaucoma, reducing the probability of blindness by 24%.
Improving access to cost-effective health services is an important public health goal. Currently, teleglaucoma is usually discussed in the context of rural communities. In some countries, such as the UK, however, it is already reality in urban areas underserved by ophthalmologists. With ageing demographics and squeezed health budgets, teleglaucoma may soon become part evreyday clinical life.
References
- Kumar S, et al. Glaucoma screening: analysis of conventional and telemedicine-friendly devices. Clin Experiment Ophthalmol 2007;35(3):237-243.
- Tuulonen A, et al. The application of teleophthalmology in examining patients with glaucoma: a pilot study. J Glaucoma 1999;8(6):367-373.
- Thomas SM, et al. The effectiveness of teleglaucoma versus in-patient examination for glaucoma screening: a systematic review and meta-analysis. PLoS One 2014;9(12):e113779.
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