A store-and-forward telemedicine for retinopathy of prematurity screen: Is it cost-effective in Thailand?

Abstract

Background: Prompt diagnosis and treatment of retinopathy of prematurity (ROP) is crucial to prevent blindness. Telemedicine for ROP diagnosis can be applied in regions that lack an expert ophthalmologist. Objectives: To assess the value-for-money of telemedicine in screening for ROP in high-risk infants. Methods: A cost-utility analysis of screening and diagnosis of ROP using telemedicine was compared with the current process for ROP screening (Thai Clinical Trials Registry Identification No. TCTR20130911001). We used decision analytical models to compare costs and outcomes in terms of quality-adjusted life years (QALY) to the health provider and society. We used one-way sensitivity analysis and probabilistic sensitivity analysis to consider parameter uncertainty. Results: The total capital cost for telemedicine to the health provider was 951,000 THB per year. With the base case analysis of 400 children screened per year per RetCam, the performance of screening and diagnosis of ROP using telemedicine (100% sensitivity and 97.8% specificity) was higher compared with the current method (88.9% sensitivity and 93.4% specificity). We therefore expect that blindness can be prevented in 3 children per 400 screening cases. The incremental cost to society of telemedicine compared with the current practice was 837 THB. Preventing just one child from becoming blind can save around 146,000 THB throughout their lifetime based on savings to welfare costs for disabled people. The incremental cost-effectiveness ratio of this telemedicine was 259 THB per case of prevented blindness and 17,397 THB per QALY saved. Conclusions: Store and forward telemedicine for ROP screening is cost-effective.