The high costs of diabetes in the United States are well known, with estimated total costs at approximately $245 billion, including $176 billion in direct medical costs each year(1). Much of this cost is attributed to comorbid conditions like kidney disease, heart disease, and eye disease. As an example, diabetic retinopathy (DR), the leading cause of blindness in working-age adults in the United States(2), accounts for $2 billion in health care costs, as well as additional indirect costs related to lost productivity. Welch Allyn and RTI Health Solutions have developed an economic model to demonstrate the effect of teleretinal screening on rates of blindness and costs of treatment.
The American Diabetes Association, along with several other professional organizations, recommends that all diabetic patients in the U.S. have an annual dilated retinal exam (DRE) to evaluate for the presence or absence of DR(3). Currently, on average, less than 65% of patients are compliant with these recommendations(4). Due to late detection of disease, many of these patients will require costly treatment and many will suffer preventable severe vision loss from DR.
As a method to increase DRE compliance and early detection of sight-threatening DR, teleretinal imaging uses specialized cameras to acquire retinal photos in primary care clinics. Ophthalmologists remotely interpret the retinal images and return a diagnostic report to the primary care provider. Patients with vision-threatening eye disease are urged to follow up with an ophthalmologist for a dilated eye exam.
The effectiveness of teleretinal imaging is well documented, with evaluation rates increasing from 30% to over 90%(5). However, this study is the first comprehensive assessment of current costs of DR and the monetary effect of the implementation of teleretinal screening.
Welch Allyn and RTI Health Solutions have developed an economic model that employs the gold-standard for cost-effectiveness models - a Markov-based approach with health states to capture: (1) the incidence and progression of DR, including progression to clinically significant macular edema (CSME) and irreversible severe vision loss; (2) the detection and treatment of vision-threatening DR and CSME; and (3) death over a 10-year time period for both the entire U.S. diabetic population as well as only the Medicare population.
Early results of the model show that with the current paradigm of DR detection, that is, referral to an ophthalmologist for a DRE by the primary care provider, the rate of blindness from DR will continue to increase over the next 10 years. Additionally, costs associated with screening and treatment will rise steadily, largely because DR is not being detected in the early stages when it can be treated effectively and cost effectively. Implementing teleretinal screening nationwide could reverse the trend and decrease the rate of severe vision loss from diabetes. In addition to preserving vision, teleretinal imaging results in a global cost savings, largely due to less-costly screening and the cost-effectiveness of early treatment. Additional statistics, including actual costs saved and percent reduction in diabetes-related blindness, will be included in the final presentation.
