Related Experiment Video
Updated: Nov 22, 2025
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
A cost-minimisation analysis comparing alternative telemedicine screening approaches for retinopathy of prematurity
Emmanuel Kim1, Kim-Huong Nguyen1, Tim Donovan2,3
1Centre for Online Health, The University of Queensland, Australia.
Insights
A traveling nurse using digital retinal photography is the most cost-effective method for screening retinopathy of prematurity (ROP) in preterm infants. This telemedicine approach reduces health system costs compared to current infant transfer practices.
Area of Science:
- Ophthalmology
- Health Economics
- Neonatal Care
Background:
- Retinopathy of prematurity (ROP) screening is vital for preventing blindness in high-risk preterm infants.
- Current ROP screening in Queensland involves costly and risky infant transfers to tertiary centers.
- Alternative telemedicine approaches are being explored to improve efficiency and reduce risks.
Purpose of the Study:
- To compare the costs of current ROP screening practices with two telemedicine alternatives.
- To identify the most cost-effective model for ROP screening in regionalized healthcare systems.
- To inform healthcare policy regarding ROP screening strategies.
Main Methods:
- A decision analytic model was used to estimate costs from a health service perspective.
- Three models were assessed: traveling nurse with digital retinal photography (DRP), equipping special care nurseries (SCNs) with DRP, and current infant transfer.
- Activity data from a tertiary ROP screening service informed the cost estimations.
Main Results:
- Equipping SCNs with DRP and training local nurses was the most expensive model (AUD$4114/infant).
- Current infant transfer practice was the second most expensive (AUD$1021/infant).
- A traveling specialist nurse with portable DRP was the most economical model (AUD$363/infant).
Conclusions:
- This is the first economic analysis in Australia comparing ROP screening costs with telemedicine approaches.
- Telemedicine, particularly non-physician screening, can enhance cost-efficiency in healthcare systems.
- Implementing telemedicine for ROP screening can maintain health outcomes while reducing infant transport risks and costs.
Introduction:
Screening for retinopathy of prematurity (ROP) is an important procedure in the prevention of blindness in high-risk preterm infants. In the regionalised healthcare system of Queensland (Australia), outside of the major centres, some preterm infants are cared for in special care nurseries (SCNs). When necessary, infants in these nurseries who are at risk of ROP are transferred to a tertiary hospital for screening by paediatric ophthalmologists. The transport of preterm infants for eye examinations adds risk and incurs significant costs to the health system. Using a cost-minimisation approach, we aimed to compare the costs of the current ROP screening practice with two alternative telemedicine approaches.
Methods:
We constructed a decision analytic model to estimate costs from a health service perspective with a five-year analysis horizon; activity data from a tertiary ROP screening service were used to inform the models. The three models assessed were: (a) a digital retinal photography (DRP)-equipped travelling nurse, (b) equipping SCNs with DRP, and providing training to local nurses, and (c) current practice of infant transfer. In all cases, the tertiary centre provides specialist ophthalmologic review.
Results:
Of the three models, we estimated the most expensive option to be equipping SCNs with DRP and providing training to local nurses (AUD$4114/infant). We found that the current practice of transferring infants was the second most expensive (AUD$1021/infant). The most economical model was the specialist nurse travelling to each SCN with a portable DRP (AUD$363/infant). A sensitivity analysis, which assessed uncertainty and variability around the cost estimates, found that the ranking for the expected costs of the alternative models of care did not change.
Discussion:
This is the first economic and cost-minimisation analysis in Australia to compare the costs of the current screening programme with two alternative telemedicine approaches for screening ROP. Telemedicine programmes that facilitate non-physician screening may improve the cost efficiency of the health system while maintaining the health outcomes for children, and reducing the risk associated with infant transport.
