The Cost-Effectiveness of a Telemedicine Screening Program for Diabetic Retinopathy in New York City

Figures & data

Table 1 Incremental Quality Adjusted Life Years Saved by Treatment

Treatment	Incremental Quality Adjusted Life Years
Cataract Surgery	0.169^Citation47
Glaucoma (Prostaglandin Agonists, Laser Trabeculoplasty)	0.0432, 0.026^Citation48
Diabetic Macular Edema and Proliferative Diabetic Retinopathy	0.18^Citation23

Table 2 Rates of Diabetic Retinopathy (DR) and Diabetic Macular Edema (DME) Seen on Fundoscopic Image Screening and Clinical Exam

Grade on Screening	Detected on Fundus Photography^a	Follow-Up Within One Year^b	Detected on Clinical Exam on Follow Up^c
DR R1 + R2 + R3^d N (%)	519 (23.1)	227 (43.7)	152 (67.0)
Background DR R1 N (%)	426 (18.9)	185 (43.4)	115 (62.2)
Pre-proliferative DR R2 N (%)	76 (3.4)	35 (46.1)	31 (88.6)
Proliferative DR R3 N (%)	17 (0.8)	7 (41.2)	6 (85.7)
No DR R0 N (%)	1607 (71.4)	513 (31.9)	468 (91.2)
Indeterminate N (%)	125 (5.5)	51 (40.8)	N/A
DME N (%)	162 (7.2)	71 (43.8)	20 (28.2)
No DME N (%)	2089 (92.8)	720 (34.5)	688 (95.6)

Notes: ^aPercentages are calculated using 2251 total patients. ^bPercentages are calculated using the second column as the dividend. ^cPercentages are calculated using the third column as the dividend. ^dR1, R2, R3 refer to the UK National Screening Committee (NSC) criteria.

Table 3 Overview of Sight Years and Quality Adjusted Life Years Saved

Diagnosis	Treated (n)	Sight Years Saved	Cost Saving ($)	Quality Adjusted Life Years Gained
Proliferative Diabetic Retinopathy	17	1.11	17,570	3.06
Diabetic Macular Edema	33	1.98	31,482	5.94
Diabetic Retinopathy-associated	50	3.09	49,052	9.00
Glaucoma	22	0.24	3848	0.93
Cataract	28	4.76	75,684	4.73
Overall	84	8.51	124,736	14.66

Table 4 Estimate of Revenue Generated

Revenue	Total ($)	Per Patient ($)	Maximum Expected ($)^a
Diabetic Retinopathy- Related	208,535	264	575,071
Non-Diabetic Retinopathy	68,265	86	189,447
Combined	276,800	350	787,708

Note: ^aAssuming 100% follow-up.

Brown GC, Brown MM, Busbee BG. Cost-utility analysis of cataract surgery in the United States for the year 2018. J Cataract Refract Surg. 2019;45:927–938. doi:10.1016/j.jcrs.2019.02.006

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