title: Cost-effectiveness analysis of telemedicine to evaluate diabetic retinopathy in a prison population.
abstract: OBJECTIVE
  A cost-effectiveness analysis was conducted to investigate the clinical and economic impact of teleophthalmology in evaluating diabetic retinopathy in prison inmates with type 2 diabetes.
  
  
  METHODS
  Based on a hypothetical teleophthalmology system to evaluate diabetic retinopathy patients with type 2 diabetes in a prison care setting, a Markov decision model was developed with probability and cost data derived primarily from published epidemiological and outcome studies. A 40-year-old African-American man with type 2 diabetes was used as a reference case subject. The number of quality-adjusted life-years (QALYs) gained was used as the clinical outcome, and the cost in U.S. dollars from the year 2003 was used as the economic outcome. Teleophthalmology and nonteleophthalmology strategies were compared using an expected QALYs calculation and two types of sensitivity analyses: probabilistic and traditional n-way sensitivity analyses.
  
  
  RESULTS
  The teleophthalmology strategy dominates in the cost-effectiveness analysis for the reference case subject: 16,514/18.73 dollars QALYs for teleophthalmology and 17,590/18.58 dollars QALYs for nonteleophthalmology. Ninety percent of the Monte Carlo simulations showed cost effectiveness (annual cost/QALYs < or = 50,000 dollars) in the teleophthalmology strategy based on an assumed inmate population. Teleophthalmology is the better strategy if the number of diabetic inmates in the prison community is >500.
  
  
  CONCLUSIONS
  Our cost-effectiveness analysis demonstrates that teleophthalmology holds great promise to reduce the cost of inmate care and reduce blindness caused by diabetic retinopathy in type 2 diabetic patients.
authors.affiliation: School of Health Information Sciences, University of Texas Health Science Center--Houston, Houston, Texas 77030, USA. noriaki.aoki@uth.tmc.edu
authors.forename: Noriaki
authors.initials: N
authors.lastname: Aoki
authors.forename: Kim
authors.initials: K
authors.lastname: Dunn
authors.forename: Tsuguya
authors.initials: T
authors.lastname: Fukui
authors.forename: J Robert
authors.initials: JR
authors.lastname: Beck
authors.forename: William J
authors.initials: WJ
authors.lastname: Schull
authors.forename: Helen K
authors.initials: HK
authors.lastname: Li
mesh_terms: D001766:Blindness / Q000453:epidemiology; D003365:Costs and Cost Analysis; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D018450:Disease Progression; D006801:Humans; D015995:Prevalence; D011329:Prisoners; D011330:Prisons; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D013781:Texas / Q000453:epidemiology