Avidor Daniel, Loewenstein Anat, Waisbourd Michael, Nutman Amir
1Sackler Faculty of Medicine, Tel-Aviv University (TAU), Tel-Aviv, Israel.
2Ophthalmology Department, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Cost Eff Resour Alloc. 2020 Apr 6;18:16. doi: 10.1186/s12962-020-00211-1. eCollection 2020.
Diabetic retinopathy (DR) is a significant global public health and economic burden. DR accounts for approximately 15-17% of all cases of total blindness in the USA and Europe. Telemedicine is a new intervention for DR screening, however, there is not enough evidence to support its cost-effectiveness. The aim of this study is to review the most recent published literature on economic evaluations of telemedicine in DR screening and summarize the evidence on the cost-effectiveness of this technology.
A systematic search of PubMed, Embase and Google Scholar for relevant articles published between January 2010 and January 2020. Studies were included if they met the following criteria: (1) recruited subjects with either type 1, type 2 diabetes (2) evaluated telemedicine technology (3) patients underwent primary screening for DR (4) compared a telemedicine-based intervention with standard care (5) performed an economic evaluation or provided sufficient data for evaluating the cost-effectiveness of the technology used.
Of 2238 articles screened, seven studies were included. Four of the studies were conducted in developed countries: The United States, Singapore and two studies in Canada. Three studies were conducted in developing countries: India, Brazil and South Africa. The patient populations in all studies were diabetic patients over the age of 18, previously not screened for DR. All seven studies used a telemedicine program which included capturing a retinal image and subsequently transmitting it to an ocular imaging center to assess the severity of DR. All studies compared telemedicine to a standard screening method for DR, including the option of no screening as standard of care. Although telemedicine requires initial and maintenance costs, it has the potential to provide significant cost savings by increasing patients' working ability, increasing independent living ability, increasing quality of life and reducing travel costs.
Diabetic retinopathy telemedicine technology has the potential to provide significant cost savings, especially in low-income populations and rural patients with high transportation costs.
糖尿病视网膜病变（DR）是一项重大的全球公共卫生和经济负担。在美国和欧洲，DR约占所有全盲病例的15 - 17%。远程医疗是DR筛查的一种新干预措施，然而，尚无足够证据支持其成本效益。本研究的目的是回顾关于远程医疗在DR筛查中经济评估的最新发表文献，并总结该技术成本效益的证据。
对PubMed、Embase和谷歌学术进行系统检索，查找2010年1月至2020年1月发表的相关文章。符合以下标准的研究纳入：（1）招募1型或2型糖尿病患者；（2）评估远程医疗技术；（3）患者接受DR初筛；（4）将基于远程医疗的干预措施与标准护理进行比较；（5）进行经济评估或提供足够数据以评估所用技术的成本效益。
在筛选的2238篇文章中，纳入了7项研究。其中4项研究在发达国家进行：美国、新加坡以及加拿大的两项研究。3项研究在发展中国家进行：印度、巴西和南非。所有研究中的患者群体均为18岁以上的糖尿病患者，此前未接受过DR筛查。所有7项研究都使用了一个远程医疗项目，该项目包括采集视网膜图像，随后将其传输到眼科成像中心以评估DR的严重程度。所有研究都将远程医疗与DR的标准筛查方法进行了比较，包括将不进行筛查作为标准护理选项。尽管远程医疗需要初始成本和维护成本，但它有可能通过提高患者的工作能力、增加独立生活能力、提高生活质量和降低交通成本来显著节省成本。
糖尿病视网膜病变远程医疗技术有可能显著节省成本，尤其是在低收入人群和交通成本高的农村患者中。
