Tele-ophthalmology screening for proliferative diabetic retinopathy in urban primary care offices: an economic analysis

Ophthalmic Surg Lasers Imaging Retina. Nov-Dec 2014;45(6):556-61. doi: 10.3928/23258160-20141118-11.


Background and objective: To determine whether tele-ophthalmology screening for proliferative diabetic retinopathy (PDR) can be cost-saving.

Patients and methods: Adults with diabetes presenting for routine medical care underwent non-mydriatic fundus photography with remote grading. Direct medical costs were estimated using the Medicare fee schedule in the base case, with Medicaid and commercial insurance rates used for low and high values, respectively. One-way and probabilistic sensitivity analyses were performed.

Results: Of 99 participants, at least mild retinopathy was found in 24 (24.2%). Urgent consultation was recommended for eight participants (8.1%) for possible vision-threatening diabetic retinopathy, including two participants (three eyes) with PDR. In the base case, screening saved $36 per patient. A Monte Carlo simulation indicated that screening saved a median of $48 per patient.

Conclusion: A substantial burden of diabetic retinopathy was identified, most of which was undiagnosed. In a closed system, tele-ophthalmology screening for PDR is likely to be cost-saving across the range of scenarios explored.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Cost-Benefit Analysis
  • Decision Trees
  • Diabetic Retinopathy / diagnosis*
  • Diabetic Retinopathy / economics
  • Diabetic Retinopathy / therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Monte Carlo Method
  • Ophthalmology / economics*
  • Photography / economics*
  • Primary Health Care / economics*
  • Sensitivity and Specificity
  • Telemedicine / economics*
  • Urban Health Services / economics*