title: Cost-effectiveness of Different Diabetic Retinopathy Screening Modalities.
abstract: Current screening strategies aimed at detection of diabetic retinopathy (DR) historically have poor compliance, but advancements in technology can enable improved access to care. Nearly 80% of all persons with diabetes live in low- and middle-income countries (LMICs), highlighting the importance of a cost effective screening program. Establishing mechanisms to reach populations with geographic and financial barriers to access is essential to prevent visual disability. Teleretinal programs leverage technology to improve access and reduce cost. The quality of currently employed screening modalities depends on many variables including the instrument used, use of pupillary mydriasis, number of photographic fields, and the qualifications of the photographer and image interpreter. Recent telemedicine and newer technological approaches have been introduced, but data for these technologies is yet limited. We present results of a systematic review of studies evaluating cost-effectiveness of DR screening, and discuss potential relevance for LMICs.
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA fpasque@emory.edu.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Pasquel
authors.affiliation: Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Hendrick
authors.affiliation: Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Ryan
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Cason
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Ali
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
mesh_terms: D003362:Cost-Benefit Analysis; D003930:Diabetic Retinopathy / Q000000981:diagnostic imaging* / Q000191:economics*; D003941:Diagnostic Techniques, Ophthalmological / Q000191:economics*; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D017216:Telemedicine / Q000191:economics / Q000379:methods
keywords: cost; diabetic retinopathy; low and middle income countries; screening; smartphones; telemedicine