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Cost-Utility Analysis of Telemedicine and Ophthalmoscopy for Retinopathy of Prematurity Management
Kevin M. Jackson, OD, MPH;
Karen E. Scott, MD, MBA;
Joshua Graff Zivin, PhD;
David A. Bateman, MD;
John T. Flynn, MD;
Jeremy D. Keenan, MD, MPH;
Michael F. Chiang, MD
Arch Ophthalmol. 2008;126(4):493-499.
Objective To evaluate the cost-effectiveness of telemedicine and standard ophthalmoscopy for retinopathy of prematurity (ROP) management.
Methods Models were developed to represent ROP examination and treatment using telemedicine and standard ophthalmoscopy. Cost-utility analysis was performed using decision analysis, evidence-based outcome data from published literature, and present value modeling. Visual outcome data were converted to patient preference–based time trade-off utility values based on published literature. Costs of disease management were determined based on 2006 Medicare reimbursements. Costs per quality-adjusted life year gained by telemedicine and ophthalmoscopy for ROP management were compared. One-way sensitivity analysis was performed on the following variables: discount rate (0%-7%), incidence of treatment-requiring ROP (1%-20%), sensitivity and specificity of ophthalmoscopic diagnosis (75%-100%), percentage of readable telemedicine images (75%-100%), and sensitivity and specificity of telemedicine diagnosis (75%-100%).
Results For infants with birth weight less than 1500 g using a 3% discount rate for costs and outcomes, the costs per quality-adjusted life year gained were $3193 with telemedicine and $5617 with standard ophthalmoscopy. Sensitivity analysis resulted in ranges of costs per quality-adjusted life year from $1235 to $18 898 for telemedicine and from $2171 to $27 215 for ophthalmoscopy.
Conclusions Telemedicine is more cost-effective than standard ophthalmoscopy for ROP management. Both strategies are highly cost-effective compared with other health care interventions.
Author Affiliations: Department of Health Policy and Management, Mailman School of Public Health (Drs Jackson and Graff Zivin), and Division of Neonatology (Drs Scott and Bateman) and Departments of Ophthalmology (Drs Flynn, Keenan, and Chiang) and Biomedical Informatics (Dr Chiang), College of Physicians and Surgeons, Columbia University, New York, New York.
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