Department of Preventive Ophthalmology, Sankara Nethralaya, Vision Research Foundation, Chennai Tamil Nadu, India.
Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Ophthalmology. 2013 Mar;120(3):566-573. doi: 10.1016/j.ophtha.2012.09.002. Epub 2012 Dec 1.
To assess the cost-effectiveness of a telemedicine diabetic retinopathy (DR) screening program in rural Southern India that conducts 1-off screening camps (i.e., screening offered once) in villages and to assess the incremental cost-effectiveness ratios of different screening intervals.
A cost-utility analysis using a Markov model.
A hypothetical cohort of 1000 rural diabetic patients aged 40 years who had not been previously screened for DR and who were followed over a 25-year period in Chennai, India.
We interviewed 249 people with diabetes using the time trade-off method to estimate utility values associated with DR. Patient and provider costs of telemedicine screening and hospital-based DR treatment were estimated through interviews with 100 diabetic patients, sampled when attending screening in rural camps (n = 50) or treatment at the base hospital in Chennai (n = 50), and with program and hospital managers. The sensitivity and specificity of the DR screening test were assessed in comparison with diagnosis using a gold standard method for 346 diabetic patients. Other model parameters were derived from the literature. A Markov model was developed in TreeAge Pro 2009 (TreeAge Software Inc, Williamstown, MA) using these data.
Cost per quality-adjusted life-year (QALY) gained from the current teleophthalmology program of 1-off screening in comparison with no screening program and the cost-utility of this program at different screening intervals.
By using the World Health Organization threshold of cost-effectiveness, the current rural teleophthalmology program was cost-effective ($1320 per QALY) compared with no screening from a health provider perspective. Screening intervals of up to a frequency of screening every 2 years also were cost-effective, but annual screening was not (>$3183 per QALY). From a societal perspective, telescreening up to a frequency of once every 5 years was cost-effective, but not more frequently.
From a health provider perspective, a 1-off DR telescreening program is cost-effective compared with no screening in this rural Indian setting. Increasing the frequency of screening up to 2 years also is cost-effective. The results are dependent on the administrative costs of establishing and maintaining screening at regular intervals and on achieving sufficient coverage.
评估在印度南部农村开展一次性远程医疗糖尿病视网膜病变（DR）筛查项目的成本效益，该项目在村庄中开展单次筛查活动（即仅提供一次筛查），并评估不同筛查间隔的增量成本效益比。
使用马尔可夫模型进行成本效用分析。
来自印度钦奈的 1000 名年龄在 40 岁的农村糖尿病患者，他们从未接受过 DR 筛查，在 25 年内进行随访。
我们通过时间权衡法采访了 249 名糖尿病患者，以估算与 DR 相关的效用值。通过采访在农村营地接受筛查的 100 名糖尿病患者（n=50）或在钦奈基地医院接受治疗的 100 名糖尿病患者（n=50），以及与项目和医院管理人员的访谈，估算远程医疗筛查和医院为 DR 治疗的患者和提供者成本。对 346 名糖尿病患者的 DR 筛查试验的灵敏度和特异性进行了评估，与使用金标准方法进行的诊断结果进行了比较。其他模型参数来自文献。使用这些数据在 TreeAge Pro 2009（TreeAge Software Inc，马萨诸塞州威廉斯敦）中开发了一个马尔可夫模型。
与不进行筛查相比，目前单次筛查的远程眼科学项目为每获得一个质量调整生命年（QALY）所付出的成本与效用，以及该项目在不同筛查间隔下的成本效益。
从卫生保健提供者的角度来看，与不进行筛查相比，目前农村远程眼科学项目具有成本效益（每获得一个 QALY 的成本为 1320 美元）。筛查间隔长达每 2 年筛查一次也具有成本效益，但每年筛查则不然（每获得一个 QALY 的成本超过 3183 美元）。从社会角度来看，每 5 年筛查一次的远程筛查是具有成本效益的，但频率更高则不然。
从卫生保健提供者的角度来看，与不进行筛查相比，在这种印度农村环境下，一次性 DR 远程筛查项目具有成本效益。增加筛查频率至每 2 年筛查一次也具有成本效益。结果取决于定期建立和维持筛查的行政成本以及实现充分覆盖的程度。
