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Review of economic evaluations of teleophthalmology as a screening strategy for chronic eye disease in adults
  1. Noha Sharafeldin1,2,
  2. Atsushi Kawaguchi1,3,
  3. Aishwarya Sundaram4,
  4. Sandy Campbell5,
  5. Chris Rudnisky6,
  6. Ezekiel Weis6,
  7. Matthew T S Tennant6,
  8. Karim F Damji6
  1. 1 School of Public Health, University of Alberta, Edmonton, Canada
  2. 2 Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3 Department of Pediatrics, Pediatric Critical Care Medicine, University of Alberta, Edmonton, Canada
  4. 4 Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
  5. 5 JW Scott Library, Health Sciences Library, University of Alberta, Edmonton, Canada
  6. 6 Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
  1. Correspondence to Dr Karim F Damji, Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of Alberta, Edmonton, AB T5H 3V9, Canada; kdamji{at}ualberta.ca

Abstract

Background/aims Teleophthalmology is well positioned to play a key role in screening of major chronic eye diseases. Economic evaluation of cost-effectiveness of teleophthalmology, however, is lacking. This study provides a systematic review of economic studies of teleophthalmology screening for diabetic retinopathy (DR), glaucoma and macular degeneration.

Methods Structured search of electronic databases and full article review yielded 20 cost-related articles. Sixteen articles fulfilled the inclusion criteria and were retained for a narrative review: 12 on DR, 2 on glaucoma and 2 on chronic eye disease.

Results Teleophthalmology for DR yielded the most cost savings when compared with traditional clinic examination. The study settings varied among urban, rural and remote settings, community, hospital and health mobile units. The most important determinant of cost-effectiveness of teleophthalmology was the prevalence of DR among patients screened, indicating an increase of cost savings with the increase of screening rates. The required patient pool size to be screened varied from 110 to 3500 patients. Other factors potentially influencing cost-effectiveness of teleophthalmology were older patient age, regular screening and full utilisation of the equipment. Teleophthalmology for glaucoma was more cost-effective compared with in-person examination. Similarly, increasing number of glaucoma patients targeted for screening yielded more cost savings.

Conclusions This economic review provides supportive evidence of cost-effectiveness of teleophthalmology for DR and glaucoma screening potentially increasing screening accessibility especially for rural and remote populations. Special selection of the targeted screening population will optimise the cost-effectiveness of teleophthalmology.

  • Teleophthalmology
  • diabetic retinopathy
  • glaucoma
  • macular degeneration
  • systematic review
  • cost-effectivness

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Footnotes

  • NS and AK are joint first authors.

  • Contributors NS and AK: conceptualised and designed the systematic review protocol, performed the systematic review, drafted and revised the initial manuscript and approved the final manuscript as submitted. SC: constructed and conducted the systematic database search, reviewed the initial manuscript and approved the final manuscript as submitted. AS: assisted with the systematic review as a third reviewer, drafted and revised the initial manuscript and approved the final manuscript as submitted. MTST and CR: reviewed and revised the manuscript and approved the final version as submitted. EW: helped refine the review and analysis methodology, reviewed and revised the initial manuscript and approved the final manuscript as submitted. KFD: conceptualised and designed the systematic review protocol, supervised the conduct of the review, reviewed and revised the initial manuscript and approved the final manuscript as submitted.

  • Funding NS received support for this project from the Department of Ophthalmology and Visual Sciences, University of Alberta. AK received support from Women and Children’s Health Research Institute and graduate stipend from School of Public Health, University of Alberta for this project.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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