Cost-Effectiveness Analysis of Telemedicine to Evaluate Diabetic Retinopathy in a Prison Population

Cost-Effectiveness Analysis of Telemedicine to Evaluate Diabetic Retinopathy in a Prison Population Noriaki Aoki , MD 1 2 , Kim Dunn , MD 1 3 , Tsuguya Fukui , MD 4 , J. Robert Beck , MD 5 , William J. Schull , PHD 3 and Helen K. Li , MD 6 1 School of Health Information Sciences, University of Texas Health Science Center–Houston, Houston, Texas 2 Center for Health Service, Outcomes Research and Development–Japan (CHORD-J), Tokyo, Japan 3 The Schull Institute, Houston, Texas 4 Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan 5 Department of Information Science and Technology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 6 Department of Ophthalmology and Visual Sciences, the University of Texas Medical Branch, Galveston, Texas Address correspondencereprint requests to Noriaki Aoki, MD, PhD, MS, FJSIM Assistant Professor, School of Health Information Sciences, University of Texas, Health Science Center–Houston, 7000 Fannin, UCT-600, Houston, TX 77030. E-mail: noriaki.aoki{at}uth.tmc.edu Abstract OBJECTIVE —A cost-effectiveness analysis was conducted to investigate the clinical and economic impact of teleophthalmology in evaluating diabetic retinopathy in prison inmates with type 2 diabetes. RESEARCH DESIGN AND METHODS —Based on a hypothetical teleophthalmology system to evaluate diabetic retinopathy patients with type 2 diabetes in a prison care setting, a Markov decision model was developed with probability and cost data derived primarily from published epidemiological and outcome studies. A 40-year-old African-American man with type 2 diabetes was used as a reference case subject. The number of quality-adjusted life-years (QALYs) gained was used as the clinical outcome, and the cost in U.S. dollars from the year 2003 was used as the economic outcome. Teleophthalmology and nonteleophthalmology strategies were compared using an expected QALYs calculation and two types of sensitivity analyses: probabilistic and traditional n -way sensitivity analyses. RESULTS —The teleophthalmology strategy dominates in the cost-effectiveness analysis for the reference case subject: $16,514/18.73 QALYs for teleophthalmology and $17,590/18.58 QALYs for nonteleophthalmology. Ninety percent of the Monte Carlo simulations showed cost effectiveness (annual cost/QALYs ≤$50,000) in the teleophthalmology strategy based on an assumed inmate population. Teleophthalmology is the better strategy if the number of di