title: Tele-ophthalmology screening for proliferative diabetic retinopathy in urban primary care offices: an economic analysis.
abstract: OBJECTIVE
  To determine whether tele-ophthalmology screening for proliferative diabetic retinopathy (PDR) can be cost-saving.
  
  
  METHODS
  Adults with diabetes presenting for routine medical care underwent non-mydriatic fundus photography with remote grading. Direct medical costs were estimated using the Medicare fee schedule in the base case, with Medicaid and commercial insurance rates used for low and high values, respectively. One-way and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Of 99 participants, at least mild retinopathy was found in 24 (24.2%). Urgent consultation was recommended for eight participants (8.1%) for possible vision-threatening diabetic retinopathy, including two participants (three eyes) with PDR. In the base case, screening saved $36 per patient. A Monte Carlo simulation indicated that screening saved a median of $48 per patient.
  
  
  CONCLUSIONS
  A substantial burden of diabetic retinopathy was identified, most of which was undiagnosed. In a closed system, tele-ophthalmology screening for PDR is likely to be cost-saving across the range of scenarios explored.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Brady
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Villanti
authors.forename: Omesh P
authors.initials: OP
authors.lastname: Gupta
authors.forename: Mark G
authors.initials: MG
authors.lastname: Graham
authors.forename: Robert C
authors.initials: RC
authors.lastname: Sergott
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009885:Ophthalmology / Q000191:economics*; D010781:Photography / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000191:economics*; D019037:Urban Health Services / Q000191:economics*