A store-and-forward telemedicine for retinopathy of prematurity screen: is it cost-effective in Thailand?
Article Category: Brief communication (Original)
Published Online: Jan 31, 2017
Page range: 665 - 673
DOI: https://doi.org/10.5372/1905-7415.0905.438
Keywords
© 2015 Phanthipha Wongwai, Pritaporn Kingkaew, Somkiat Asawaphureekorn, Tharatip Kolatat
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
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Comparing direct medical costs of telemedicine with the current practice
Costs | Current practice | Telemedicine |
|---|---|---|
Indirect ophthalmoscope | 9,972 | |
Lens 20/28 diopters | 997 | |
Scleral depressor | 712 | |
Lid speculum | 142 | 142 |
RetCam Shuttle | 498,597 | |
Vehicle | 142,456 | |
Training (start-up) | 2,500 | |
997 | 49,860 | |
Nurse | 87 | 9 |
General ophthalmologist | 19 | – |
Technician/photographer | – | 12 |
Expert ophthalmologist | – | 10 |
Medicines | 4 | 20 |
Gas | 650 | |
Total fix cost (per year) | 12,820 | 693,555 |
Number of infants screened | 400 | 400 |
Unit cost per case screen | 142 | 2,434 |
Values and distributions and sources of parameters used in the decision analytic model
Parameters | Mean (SE) | Parameter distribution | Sources |
|---|---|---|---|
Prevalence of ROP in high-risk infants | 9.0% (2.9%) | Beta | Trial |
Proportion of ROP in both eyes | 88.9% (9.9%) | Beta | Trial |
Yearly probability of dying in general population | Age-dependent | – | [ |
Proportion of referrals from IO by general | 14.0% (3.5%) | Beta | Trial |
ophthalmologists | |||
Proportion of referrals from RetCam | 11.2% (3.2%) | Beta | Trial |
Sensitivity of IO by general ophthalmologists | 88.9% (95% CI: 57%-98%) | Beta | Trial |
Specificity of IO by general ophthalmologists | 93.4% (95% CI: 86%-97%) | Beta | Trial |
Sensitivity of RetCam by expert ophthalmologists | 100.0% (95% CI: 70%-100%) | Beta | Trial |
Specificity of RetCam by expert ophthalmologists | 97.8% (95% CI: 92%-99%) | Beta | Trial |
Proportion of non-interpretable photo | 2.0% (1.4%) | Beta | Trial |
Proportion of ROP in non-interpretable photo | 50.0% (28.9%) | Beta | Trial |
General ophthalmologist monthly salary | 20,000 (6,000) | Gamma | Trial |
Nurse monthly salary | 15,000 (4,500) | Gamma | Trial |
Photographer monthly salary | 8,000 (2,400) | Gamma | Trial |
Expert ophthalmologist monthly salary | 20,000 (6,000) | Gamma | Trial |
Training costs | 2,500 (750) | Gamma | Trial |
Cost of follow-up per visit | 291 (87) | Gamma | |
Cost of retinal detachment | 5,754 (1,726) | Gamma | |
Cost of laser treatment | 1,053 (316) | Gamma | |
Time use for providing telemedicine (minutes) | |||
General ophthalmologist | 10 (3) | ||
Nurse | 60 (18) | Gamma | Trial |
Expert ophthalmologist (after screening) | 60 (18) | ||
Time use for providing telemedicine (minutes) | |||
Photographer | 15 (5) | ||
Nurse | 6 (2) | Gamma | Trial |
Expert ophthalmologist | 5 (2) | ||
Number of follow-ups | Assumption | ||
For retinal detachment | 6 | ||
For laser treatment | 3 | ||
For low risk of ROP | 5 | ||
Fuel | 2,149 (285) | Gamma | Trial |
Staff | 1,791 (276) | Gamma | Trial |
Parental income loss per visit | 965(144) | Gamma | Trial |
Travelling cost | 1,794 (2,056) | Gamma | Trial |
Food cost | 343 (318) | Gamma | Trial |
Accommodation cost | 1,156 (159) | Gamma | Trial |
Government subsidy per year | 5,000 | ||
Probability of unfavorable outcome (blind/low vision) 9.82% (1.62%) | Beta | [ | |
from laser treatment | |||
Hazard ratio of death for some VI versus no VI | 1.23 (95% CI: 1.16-1 . 3 1 ) | Log normal | [ |
Hazard ratio of death for severe VI versus no VI | 1.54 (95% CI: 1.28-1 . 8 6 ) | Log normal | [ |
Utility for unilateral blindness | 0.89 (0.0079) | Beta | [ |
Utility for bilateral blindness | 0.81 (0.0098) | Beta | [ |