School of Public Health, University of Alberta, Edmonton, Canada.
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Br J Ophthalmol. 2018 Nov;102(11):1485-1491. doi: 10.1136/bjophthalmol-2017-311452. Epub 2018 Apr 21.
BACKGROUND/AIMS: Teleophthalmology is well positioned to play a key role in screening of major chronic eye diseases. Economic evaluation of cost-effectiveness of teleophthalmology, however, is lacking. This study provides a systematic review of economic studies of teleophthalmology screening for diabetic retinopathy (DR), glaucoma and macular degeneration.
Structured search of electronic databases and full article review yielded 20 cost-related articles. Sixteen articles fulfilled the inclusion criteria and were retained for a narrative review: 12 on DR, 2 on glaucoma and 2 on chronic eye disease.
Teleophthalmology for DR yielded the most cost savings when compared with traditional clinic examination. The study settings varied among urban, rural and remote settings, community, hospital and health mobile units. The most important determinant of cost-effectiveness of teleophthalmology was the prevalence of DR among patients screened, indicating an increase of cost savings with the increase of screening rates. The required patient pool size to be screened varied from 110 to 3500 patients. Other factors potentially influencing cost-effectiveness of teleophthalmology were older patient age, regular screening and full utilisation of the equipment. Teleophthalmology for glaucoma was more cost-effective compared with in-person examination. Similarly, increasing number of glaucoma patients targeted for screening yielded more cost savings.
This economic review provides supportive evidence of cost-effectiveness of teleophthalmology for DR and glaucoma screening potentially increasing screening accessibility especially for rural and remote populations. Special selection of the targeted screening population will optimise the cost-effectiveness of teleophthalmology.
背景/目的：远程眼科学在筛选主要慢性眼病方面具有重要作用。然而，远程眼科学的成本效益经济评价还很缺乏。本研究对远程眼科筛查糖尿病视网膜病变（DR）、青光眼和黄斑变性的经济性研究进行了系统回顾。
通过电子数据库进行结构化搜索并进行全文审查，共获得 20 篇与成本相关的文章。有 16 篇文章符合纳入标准，并被保留进行叙述性综述：12 篇关于 DR，2 篇关于青光眼，2 篇关于慢性眼病。
与传统的临床检查相比，远程眼科学在 DR 筛查方面节省了最多的成本。研究地点包括城市、农村和偏远地区、社区、医院和流动医疗单位。远程眼科学成本效益的最重要决定因素是接受筛查的患者中 DR 的患病率，表明随着筛查率的增加，成本节约也随之增加。需要筛查的患者数量从 110 人到 3500 人不等。可能影响远程眼科学成本效益的其他因素包括患者年龄较大、定期筛查和设备的充分利用。与面对面检查相比，远程眼科学在筛查青光眼方面更具成本效益。同样，针对更多的青光眼患者进行筛查也能带来更多的成本节约。
本经济回顾提供了支持性证据，表明远程眼科学在 DR 和青光眼筛查方面具有成本效益，这可能会增加筛查的可及性，特别是对农村和偏远地区的人群。对目标筛查人群的特殊选择将优化远程眼科学的成本效益。
