title: The Cost-Effectiveness Analysis of Teleglaucoma Screening Device.
abstract: Glaucoma is the leading cause of irreversible vision loss and costs the American economy $2.9 billion. Teleglaucoma remotely detects glaucoma improving access to ophthalmic care in rural areas. It helps manage glaucoma more efficiently to preserve vision and reduce healthcare costs. A cost-effectiveness analysis was conducted using healthcare provider or third-party payer perspective within rural Canada. The study population were patients at-risk of glaucoma which includes those with diabetes and/or hypertension, family history of glaucoma, adults older than 50 years, and concurrent ocular conditions in rural Alberta. Markov modelling was used to model glaucoma health states. Effectiveness was measured in Quality-Adjusted Life Years (QALYs) and costs were used in Canadian dollars. Using TreeAge Pro 2009, incremental cost-effectiveness ratios (ICER) were developed in dollars per QALYs. Deterministic and probabilistic sensitivity analyses were performed to assess the factors affecting cost-effectiveness. Teleglaucoma had a 20% increase in ophthalmologist-referral rate; it reduced patient travel times by 61 hours and physician wait times by 30% in comparison to in-person examination (standard of care). Teleglaucoma costs $872 per patient screened which was 80% less than in-person examination. Teleglaucoma had a greater incremental effectiveness providing an additional 0.12 QALY per patient examination. It was more sensitive (86.5%) and less specific (78.6%) than in-person examination. Teleglaucoma was more cost-effective than in-person examination with an ICER of-$27,460/QALY. This indicated that teleglaucoma will save $27, 460 for each additional QALY gained. Long term benefits showed teleglaucoma prevents 24% cases of glaucoma blindness after 30 years. Teleglaucoma demonstrated improved health outcomes, as well as, cost benefits. It increases access to ophthalmic care and improves healthcare service efficiency, specifically in rural areas. Teleglaucoma is more cost-effective than current in-person examination and can improve the quality of life in glaucoma patients.
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada.
authors.forename: Sera
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada; Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care London, London, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Hodge
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada; Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care London, London, Canada.
authors.forename: Monali
authors.initials: M
authors.lastname: Malvankar-Mehta
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D003362:Cost-Benefit Analysis; D005901:Glaucoma / Q000175:diagnosis* / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D059039:Standard of Care / Q000191:economics; D017216:Telemedicine / Q000191:economics*