Natera, Inc., San Carlos, California.
Georgia Institute of Technology, Atlanta, Georgia.
Ophthalmology. 2013 Dec;120(12):2604-2610. doi: 10.1016/j.ophtha.2013.06.029. Epub 2013 Sep 29.
To explore the cost-effectiveness of telemedicine for the screening of diabetic retinopathy (DR) and identify changes within the demographics of a patient population after telemedicine implementation.
A retrospective medical chart review (cohort study) was conducted.
A total of 900 type 1 and type 2 diabetic patients enrolled in a medical system with a telemedicine screening program for DR.
The cost-effectiveness of the DR telemedicine program was determined by using a finite-horizon, discrete time, discounted Markov decision process model populated by parameters and testing frequency obtained from patient records. The model estimated the progression of DR and determined average quality-adjusted life years (QALYs) saved and average additional cost incurred by the telemedicine screening program.
Diabetic retinopathy, macular edema, blindness, and associated QALYs.
The results indicate that telemedicine screening is cost-effective for DR under most conditions. On average, it is cost-effective for patient populations of >3500, patients aged <80 years, and all racial groups. Observable trends were identified in the screening population since the implementation of telemedicine screening: the number of known DR cases has increased, the overall age of patients receiving screenings has decreased, the percentage of nonwhites receiving screenings has increased, the average number of miles traveled by a patient to receive a screening has decreased, and the teleretinal screening participation is increasing.
The current teleretinal screening program is effective in terms of being cost-effective and increasing population reach. Future screening policies should give consideration to the age of patients receiving screenings and the system's patient pool size because our results indicate it is not cost-effective to screen patients aged older than 80 years or in populations with <3500 patients.
探索糖尿病视网膜病变（DR）远程医疗筛查的成本效益，并确定远程医疗实施后患者人群的人口统计学特征变化。
回顾性病历审查（队列研究）。
共纳入参加 DR 远程医疗筛查计划的医疗系统中的 900 名 1 型和 2 型糖尿病患者。
使用有限期、离散时间、贴现马尔可夫决策过程模型来确定 DR 远程医疗计划的成本效益，该模型由从患者记录中获得的参数和测试频率进行填充。该模型估计了 DR 的进展，并确定了远程医疗筛查计划节省的平均质量调整生命年（QALYs）和额外的平均成本。
糖尿病视网膜病变、黄斑水肿、失明和相关的 QALYs。
结果表明，在大多数情况下，远程医疗筛查对 DR 具有成本效益。平均而言，对于 >3500 名患者、<80 岁的患者以及所有种族群体，远程医疗筛查都是具有成本效益的。自远程医疗筛查实施以来，在筛查人群中观察到了一些趋势：已知 DR 病例的数量有所增加，接受筛查的患者的总体年龄有所下降，接受筛查的非白人比例有所增加，患者接受筛查的平均旅行里程有所减少，远程视网膜筛查的参与度也在增加。
目前的远程视网膜筛查计划在成本效益和扩大人群覆盖方面是有效的。未来的筛查政策应考虑到接受筛查的患者年龄和系统的患者人群规模，因为我们的结果表明，对年龄大于 80 岁或患者人数少于 3500 人的患者进行筛查是不具有成本效益的。
