Economic Evaluation of Diabetic Retinopathy Screening in Developing Countries: A Systematic Review

Area of Science:

• Ophthalmology
• Health Economics
• Digital Health

Background:

• Diabetic retinopathy (DR) poses a significant public health challenge, particularly in developing countries.
• Effective screening strategies are crucial for early detection and prevention of vision loss.
• Existing standard care for DR screening may be limited in accessibility and cost-effectiveness in resource-constrained settings.

Purpose of the Study:

• To evaluate the economic aspects of diabetic retinopathy (DR) screening strategies in developing countries.
• To compare the cost-effectiveness of artificial intelligence (AI) and telemedicine interventions against standard care for DR screening.

Main Methods:

• A systematic literature search was performed across major scientific databases (PubMed, ScienceDirect, Cochrane Library, Google Scholar).
• Included studies focused on type 1 or type 2 diabetes mellitus patients in low- or middle-income countries.
• Studies compared AI or telemedicine interventions with standard care, incorporating health economic assessments.

Main Results:

• Seven studies from China, Thailand, Brazil, and India were included, utilizing cost-utility and cost-effectiveness analyses.
• Evaluated interventions included AI-based screening, telemedicine, and combined AI-assisted telemedicine models.
• All reviewed strategies demonstrated cost-effectiveness compared to standard care, with varying degrees of economic benefit.

Conclusions:

• AI and telemedicine-based DR screening are supported as cost-effective and feasible options for developing countries.
• While generally economically viable, the extent of cost savings and health gains is influenced by the specific model, setting, and assumptions.
• Key factors for successful implementation include appropriate screening frequency and high patient compliance.