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      Cost-effectiveness of diabetic retinopathy screening programs using telemedicine: a systematic review

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          Abstract

          Background

          Diabetic retinopathy (DR) is a significant global public health and economic burden. DR accounts for approximately 15–17% of all cases of total blindness in the USA and Europe. Telemedicine is a new intervention for DR screening, however, there is not enough evidence to support its cost-effectiveness. The aim of this study is to review the most recent published literature on economic evaluations of telemedicine in DR screening and summarize the evidence on the cost-effectiveness of this technology.

          Methods

          A systematic search of PubMed, Embase and Google Scholar for relevant articles published between January 2010 and January 2020. Studies were included if they met the following criteria: (1) recruited subjects with either type 1, type 2 diabetes (2) evaluated telemedicine technology (3) patients underwent primary screening for DR (4) compared a telemedicine-based intervention with standard care (5) performed an economic evaluation or provided sufficient data for evaluating the cost-effectiveness of the technology used.

          Results

          Of 2238 articles screened, seven studies were included. Four of the studies were conducted in developed countries: The United States, Singapore and two studies in Canada. Three studies were conducted in developing countries: India, Brazil and South Africa. The patient populations in all studies were diabetic patients over the age of 18, previously not screened for DR. All seven studies used a telemedicine program which included capturing a retinal image and subsequently transmitting it to an ocular imaging center to assess the severity of DR. All studies compared telemedicine to a standard screening method for DR, including the option of no screening as standard of care. Although telemedicine requires initial and maintenance costs, it has the potential to provide significant cost savings by increasing patients’ working ability, increasing independent living ability, increasing quality of life and reducing travel costs.

          Conclusions

          Diabetic retinopathy telemedicine technology has the potential to provide significant cost savings, especially in low-income populations and rural patients with high transportation costs.

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          Most cited references 23

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          Global data on visual impairment in the year 2002.

          This paper presents estimates of the prevalence of visual impairment and its causes in 2002, based on the best available evidence derived from recent studies. Estimates were determined from data on low vision and blindness as defined in the International statistical classification of diseases, injuries and causes of death, 10th revision. The number of people with visual impairment worldwide in 2002 was in excess of 161 million, of whom about 37 million were blind. The burden of visual impairment is not distributed uniformly throughout the world: the least developed regions carry the largest share. Visual impairment is also unequally distributed across age groups, being largely confined to adults 50 years of age and older. A distribution imbalance is also found with regard to gender throughout the world: females have a significantly higher risk of having visual impairment than males. Notwithstanding the progress in surgical intervention that has been made in many countries over the last few decades, cataract remains the leading cause of visual impairment in all regions of the world, except in the most developed countries. Other major causes of visual impairment are, in order of importance, glaucoma, age-related macular degeneration, diabetic retinopathy and trachoma.
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            Projection of diabetic retinopathy and other major eye diseases among people with diabetes mellitus: United States, 2005-2050.

            To estimate the number of people with diabetic retinopathy (DR), vision-threatening DR (VTDR), glaucoma, and cataracts among Americans 40 years or older with diagnosed diabetes mellitus for the years 2005-2050. Using published prevalence data of DR, VTDR, glaucoma, and cataracts and data from the National Health Interview Survey and the US Census Bureau, we projected the number of Americans with diabetes with these eye conditions. The number of Americans 40 years or older with DR and VTDR will triple in 2050, from 5.5 million in 2005 to 16.0 million for DR and from 1.2 million in 2005 to 3.4 million for VTDR. Increases among those 65 years or older will be more pronounced (2.5 million to 9.9 million for DR and 0.5 million to 1.9 million for VTDR). The number of cataract cases among whites and blacks 40 years or older with diabetes will likely increase 235% by 2050, and the number of glaucoma cases among Hispanics with diabetes 65 years or older will increase 12-fold. Future increases in the number of Americans with diabetes will likely lead to significant increases in the number with DR, glaucoma, and cataracts. Our projections may help policy makers anticipate future demands for health care resources and possibly guide the development of targeted interventions. Efforts to prevent diabetes and to optimally manage diabetes and its complications are needed.
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              Evaluation of telemedicine for screening of diabetic retinopathy in the Veterans Health Administration.

              To explore the cost-effectiveness of telemedicine for the screening of diabetic retinopathy (DR) and identify changes within the demographics of a patient population after telemedicine implementation.
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                Author and article information

                Contributors
                Mirond88@gmail.com
                anatl@tlvmc.gov.il
                michaelwa@tlvmc.gov.il
                anutman@gmail.com
                Journal
                Cost Eff Resour Alloc
                Cost Eff Resour Alloc
                Cost Effectiveness and Resource Allocation : C/E
                BioMed Central (London )
                1478-7547
                6 April 2020
                6 April 2020
                2020
                : 18
                Affiliations
                [1 ]GRID grid.12136.37, ISNI 0000 0004 1937 0546, Sackler Faculty of Medicine, , Tel-Aviv University (TAU), ; Tel-Aviv, Israel
                [2 ]GRID grid.413449.f, ISNI 0000 0001 0518 6922, Ophthalmology Department, , Tel-Aviv Sourasky Medical Center, ; Tel-Aviv, Israel
                [3 ]GRID grid.413449.f, ISNI 0000 0001 0518 6922, Glaucoma Research Center, , Tel-Aviv Sourasky Medical Center, ; Tel-Aviv, Israel
                [4 ]GRID grid.413449.f, ISNI 0000 0001 0518 6922, Tel-Aviv Sourasky Medical Center and National Center for Infection Control, ; Tel-Aviv, Israel
                Article
                211
                10.1186/s12962-020-00211-1
                7137317
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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                © The Author(s) 2020

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