An economic evaluation of a store-and-forward teleophthalmology system for diabetic retinopathy among type 2 diabetic patients in The Netherlands

Objective – Investigate the cost-effectiveness of a store-and-forward teleophthalmology system in a routine ophthalmic care process compared to conventional ophthalmic care, consisting of two different processes (lab or hospital), from a societal perspective for type II diabetic patients at risk of diabetic retinopathy in The Netherlands in 2011. Methods – A cost-effectiveness analysis was performed to compare the costs and effect for a DM-II patient care episode between teleophthalmology and conventional ophthalmic care by the use of a model-based approach. The cost measures consisted of the health sector costs, patient/family costs, and productivity losses. The effectiveness measure was the proportion of fundusscreenings without physical consultation follow-up. Univariate sensitivity analysis and probabilistic sensitivity analysis were applied to investigate the impact of parameter uncertainty on the final study results. Additional outcomes of the application of teleophthalmology consultation were assessed separately from the cost-effectiveness analysis. Results – From the societal perspective the teleophthalmology process resulted on average in €0.76 lower costs and a 4.21% higher effectiveness for a patient care episode compared to the conventional lab process. The application of teleophthalmology consultation resulted in 56.22% less physical consultations and 24.24% teleophthalmology consultations created for additional advice compared to conventional ophthalmic care. In addition, it was associated with a helpfulness effect of 96.14% and a learning effect of 85.62%. The teleophthalmology consultation response time of ophthalmologists was mainly within three working days. Conclusions – Implementing teleophthalmology on a larger scale in The Netherlands could be considered for the ophthalmic care process of type II diabetic patients at risk of diabetic retinopathy.