1002. A Modeled Economic Analysis of a Digital Teleophthalmology System
John D Whited, MD, MHS, Durham VAMC and Duke University, SK Datta, Durham VAMC and Duke University, LM Aiello, Beetham Eye Institute and Harvard Medical School, JD Cavallerano, Beetham Eye Institute, Havard Medical School, PR Conlin, Brigham and Women's Hospital and VA Boston Healthcare System and Harvard Medical School, MB Horton, Phoenix Indian Medical Center, RA Vigersky, Walter Reed Army Medical Center, RK Poropatich, Walter Reed Army Medical Center, P Challa, Duke University Medical Center, AW Darkins, Veterans Healthcare Administration Telemedicine Stategic Healthcare Group, S Bursell, Beetham Eye Institute and Harvard Medical School

Objectives: Compare the cost-effectiveness of a nonmydriatic digital teleophthalmology system (Joslin Vision Network) versus traditional ophthalmoscopy examinations with pupil dilation for the detection of proliferative diabetic retinopathy and its consequences.

Methods: Using decision analytic techniques, we modeled the cost-effectiveness of each examination modality for the entire diabetic population of the Department of Veterans Affairs. Data sources for costs and outcomes included the published literature, epidemiologic data, administrative data, market data, and expert opinion.

Results: In the base-case analyses, the Joslin Vision Network was a dominant strategy, meaning that it was both less costly and more effective. Compared to ophthalmoscopy, use of the Joslin Vision Network in the Department of Veterans Affairs would detect an additional 288 cases of proliferative diabetic retinopathy and lower costs by $4,970,000. Two hundred-eighteen additional patients would be treated with panretinal laser photocoagulation at a cost savings of $4,700,000. Ten additional cases of severe vision loss (20/400 or worse) would be averted while saving $4,500,000. In sensitivity analyses, the results were robust across most of the variables.

Conclusions: Based on our economic model, a nonmydriatic digital teleophthalmology system was more effective and less costly than clinic-based ophthalmoscopy for detecting and treating proliferative diabetic retinopathy and averting cases of severe vision loss.

Impact: Diabetes is a highly prevalent disease among VA patients. Teleophthalmology systems, such as the Joslin Vision Network, may improve the visual outcomes of patients with diabetes in the VA and do so at a lower cost than traditional care.