title: Cost-utility analysis of telemedicine and ophthalmoscopy for retinopathy of prematurity management.
abstract: 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.
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Jackson
authors.forename: Karen E
authors.initials: KE
authors.lastname: Scott
authors.forename: Joshua
authors.initials: J
authors.lastname: Graff Zivin
authors.forename: David A
authors.initials: DA
authors.lastname: Bateman
authors.forename: John T
authors.initials: JT
authors.lastname: Flynn
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chiang
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D017075:Laser Coagulation; D009887:Ophthalmoscopy / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012178:Retinopathy of Prematurity / Q000191:economics* / Q000601:surgery; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000191:economics*; D014792:Visual Acuity