title: Cost-effectiveness of a National Telemedicine Diabetic Retinopathy Screening Program in Singapore.
abstract: To determine the incremental cost-effectiveness of a new telemedicine technician-based assessment relative to an existing model of family physician (FP)-based assessment of diabetic retinopathy (DR) in Singapore from the health system and societal perspectives.
  
  
  
  Model-based, cost-effectiveness analysis of the Singapore Integrated Diabetic Retinopathy Program (SiDRP).
  
  
  
  A hypothetical cohort of patients aged 55 years with type 2 diabetes previously not screened for DR.
  
  
  
  The SiDRP is a new telemedicine-based DR screening program using trained technicians to assess retinal photographs. We compared the cost-effectiveness of SiDRP with the existing model in which FPs assess photographs. We developed a hybrid decision tree/Markov model to simulate the costs, effectiveness, and incremental cost-effectiveness ratio (ICER) of SiDRP relative to FP-based DR screening over a lifetime horizon. We estimated the costs from the health system and societal perspectives. Effectiveness was measured in terms of quality-adjusted life-years (QALYs). Result robustness was calculated using deterministic and probabilistic sensitivity analyses.
  
  
  
  The ICER.
  
  
  
  From the societal perspective that takes into account all costs and effects, the telemedicine-based DR screening model had significantly lower costs (total cost savings of S$173 per person) while generating similar QALYs compared with the physician-based model (i.e., 13.1 QALYs). From the health system perspective that includes only direct medical costs, the cost savings are S$144 per person. By extrapolating these data to approximately 170 000 patients with diabetes currently being screened yearly for DR in Singapore's primary care polyclinics, the present value of future cost savings associated with the telemedicine-based model is estimated to be S$29.4 million over a lifetime horizon.
  
  
  
  While generating similar health outcomes, the telemedicine-based DR screening using technicians in the primary care setting saves costs for Singapore compared with the FP model. Our data provide a strong economic rationale to expand the telemedicine-based DR screening program in Singapore and elsewhere.
authors.affiliation: School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada.
authors.forename: Hai V
authors.initials: HV
authors.lastname: Nguyen
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Gavin Siew Wei
authors.initials: GS
authors.lastname: Tan
authors.affiliation: Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia; School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom.
authors.forename: Robyn Jennifer
authors.initials: RJ
authors.lastname: Tapp
authors.affiliation: Health Services and Systems Research, Duke NUS Medical School, Singapore.
authors.forename: Shweta
authors.initials: S
authors.lastname: Mital
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Daniel Shu Wei
authors.initials: DS
authors.lastname: Ting
authors.affiliation: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.
authors.forename: Hon Tym
authors.initials: HT
authors.lastname: Wong
authors.affiliation: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.
authors.forename: Colin S
authors.initials: CS
authors.lastname: Tan
authors.affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.
authors.forename: Augustinus
authors.initials: A
authors.lastname: Laude
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.affiliation: Department of Research, SingHealth Polyclinics, Singapore.
authors.forename: Ngiap Chuan
authors.initials: NC
authors.lastname: Tan
authors.affiliation: Health Services and Systems Research, Duke NUS Medical School, Singapore.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Finkelstein
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Medicine Research Institute, Duke NUS Medical School, Singapore.
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Medicine Research Institute, Duke NUS Medical School, Singapore. Electronic address: ecosse@unimelb.edu.au.
authors.forename: Ecosse L
authors.initials: EL
authors.lastname: Lamoureux
mesh_terms: D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012846:Singapore / Q000453:epidemiology; D017216:Telemedicine / Q000191:economics*