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Study: Telemedicine screening for proliferative diabetic retinopathy makes economic sense
In a simulation, screening saved $36 per patient vs. no screening.
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Compared with no screening, telemedicine screening for proliferative diabetic retinopathy in an urban primary care office saved $36 per patient over the long term, according to an economic simulation study.
“Our current rates of compliance with diabetic retinopathy screening guidelines are poor nationwide,” lead investigator Christopher J. Brady, MD, said. “Telemedicine is a potential means for increasing our rates of screening compliance. Assuming all of the medical barriers can be overcome, cost is a chief remaining barrier.”
Study design
The study, which appeared in Ophthalmic Surgery, Lasers and Imaging Retina, was divided into two phases. Phase 1 enrolled 204 eyes of 102 patients, collected clinical data from the primary care clinic and transmitted images to a remote expert reader for grading. At least mild retinopathy was detected in approximately 25% of patients. Phase 2 was the economic simulation, using screening costs based on the 2013 Medicare fee schedule, plus per-patient treatment costs using Medicare, Medicaid and commercial insurance rates.
Brady said he suspects that the cost savings in a rural setting would be comparable to that of an urban setting.
“We tried to make the results as generalizable as possible. However, the rates for Medicare reimbursement do vary, depending on the geographic setting,” he said.
Savings in context
Although $36 per patient does not appear to be much of a savings, the amount should be considered in the context of a larger system of care, Brady told Ocular Surgery News.
“For someone designing a telemedicine screening program, the dollar figures to consider include the cost of purchasing a fundus camera, with a price tag of perhaps $60,000, paying a person to do the interpretation of the images and training an office staff,” Brady said. “But if you can identify disease at an earlier time point, then the treatments that are needed earlier in the disease course are less expensive than the treatments that would be needed later in the time course.”
The abstract amount of $36 per patient takes into account the cost of treatment for early proliferative diabetic retinopathy with laser, for example, as opposed to treatment for late proliferative diabetic retinopathy with surgery.
“The $36 also represents the cost of screening each individual who does not need treatment,” Brady said.
The study cites a scenario in which the $10,000 purchase price of a basic fundus camera would be recouped after 278 screenings at $36 each.
A Monte Carlo simulation found that screening for proliferative diabetic retinopathy saved even more money, a median of $48 per person, due to a sophisticated computer algorithm that took into account more variables, such as a 1% or 2% rate of disease, or a laser charge of $900 vs. $1,200.
“Frankly, I did not necessarily expect that most of the simulations would show cost savings because a successful intervention does not need to be cost saving,” Brady said. “The fact that through our simulation we showed that the overwhelming majority of the time was cost saving came as a surprise to me.”
The study focused on the costs associated with detection and treatment of proliferative diabetic retinopathy.
“Results would be very different if we tried to model diabetic macular edema,” Brady said. “However, we did not pursue DME for a number of reasons, foremost, the complexity of treatment algorithms. Savings for DME would likely be less per person because you would be detecting people who needed treatment and that treatment would be very expensive, whereas in the no-screening arm, if you are waiting for patients to come in who need treatment, they may come in later, so you are saving money on those people not presenting for care.” – by Bob Kronemyer
Reference:
Brady CJ, et al. Ophthalmic Surg Lasers Imaging Retina. 2014;doi:10.3928/23258160-20141118-11.For more information:
Christopher J. Brady, MD, can be reached at Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287; 410-502-2789; email: brady@jhmi.edu.Disclosure: Brady has no relevant financial disclosures.