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Cost-effectiveness analysis of tele-retinopathy of prematurity screening in Iran
Seyed-Farzad Mohammadi1, Ameneh Rahban2, Sahel Darabeigi1
1Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 6719851351, Iran.
Insights
Implementing a tele-retinopathy of prematurity (ROP) screening program is highly cost-effective. This telemedicine approach offers significant value, making it a priority for healthcare budgets.
Area of Science:
- Ophthalmology
- Public Health
- Health Economics
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Early detection and treatment of ROP are crucial to prevent vision loss.
- Telemedicine offers a potential solution for expanding ROP screening access.
Purpose of the Study:
- To perform a cost-utility analysis comparing a tele-ROP screening program with no screening.
- To evaluate the cost-effectiveness of telemedicine for ROP detection from a societal perspective.
Main Methods:
- A decision tree model was utilized to compare tele-screening with no screening.
- Quality-adjusted life years (QALYs) were used to measure effectiveness, with a 0.058 discount rate.
- Direct medical and non-medical costs were included, analyzed using a bottom-up approach and Monte Carlo simulation.
Main Results:
- The tele-ROP screening system requires an initial investment of over $1.5 million.
- The cost per ROP case identified and treated was $108.72 for tele-screening versus $63.52 for no screening.
- Tele-screening yielded higher QALYs (15.39) compared to no screening (15.11), with an ICER of $161.43 per QALY gained.
Conclusions:
- The tele-ROP screening program is a highly cost-effective intervention within the Iranian healthcare system.
- This program warrants high priority for budget allocation due to its demonstrated value.
- Telemedicine significantly improves ROP screening outcomes and resource utilization.
Aim:
To conduct a cost-utility analysis of the tele-retinopathy of prematurity (ROP) screening program against no screening.
Methods:
A decision tree model was developed to identify and treat the infants with threshold ROP through the tele-screening system compared with no screening program from the societal perspective. We used the quality adjusted life years (QALY) index to measure the scenarios' effectiveness, which was discounted for the future years by 0.058. One hundred twenty-six randomly selected newborns with ROP required treatment were investigated to extract the treatment information. We considered the direct medical and non-medical costs in cost calculations analysed by the bottom-up approach. The figures of the model's inputs were calculated using the Monte Carlo simulation that generated 1000 random iteration of the data, and a one-way sensitivity analysis was performed on the model to cope with the potential uncertainties.
Results:
The total and per capita needed the budget to establish a tele-ROP screening system were estimated at over 1.5 million and 35.13 USD, respectively. The total cost of identifying and treating an ROP case in tele-screening and no screening strategies were obtained as 108.72 and 63.52 USD, respectively, and their lifetime discounted QALY gained were calculated as 15.39 and 15.11, respectively. Therefore, incremental cost-effectiveness ratio (ICER) of tele-screening strategy against the competitive strategy was achieved as 161.43 USD.
Conclusion:
Tele-ROP screening program is one of the most cost-effective interventions in the Iranian health system and has a high priority to receive a budget for implementation.
