Economic evaluation of Peek (Portable Eye Examination Kit) for diabetic retinopathy screening

Abstract

Diabetic retinopathy (DR) is a common eye complication in diabetes mellitus (DM) and can result in visual impairment and blindness. However, it is preventable and curable if identified and treated early. Nevertheless, the increasing burden of DM, expensive imaging devices and lack of ophthalmologists make implementing DR screening a challenge, especially in developing countries. The International Centre for Eye Health at LSHTM led a collaboration to develop the Portable Eye Examination Kit (Peek), a low-cost mHealth technology enabling retinal imaging, without need for high levels of training or infrastructure. Hence, GPs and nurses can take retinal images anytime and send these via cloud for remote grading. We developed a questionnaire to explore necessary resources for DR screening (staff, equipment, consumables) and likelihood of using Peek. A trained interviewer administered it to 24 staff facilities in Kilimanjaro region of Tanzania and collected data using Magpi. A cost-effectiveness analysis was performed with provider perspective. Uncertainty was assessed in different scenarios of utilization rate and DR prevalence. Cost per patient screened and per case detected were the outcomes measured. Since 2010 a hospital in Moshi has provided DR screening with only 1 Topcon retinal camera, delivering outreach service to remote clinics 1 day/month. Staff of 14 facilities (58%) declared to be very likely and 6 (25%) to be likely to use Peek. Known DM patients were 5,730 and the proportion yearly screened with Topcon has been approximately 20%; instead, with Peek, the target is to screen up to 80%. Considering this scenario of utilization rate, the cost per patient screened is $27 with Topcon against $5 with Peek, while the cost per case detected is $145 against $28 at 20% DR prevalence among DM patients. Peek demonstrates to be cost-effective and a potential disruptive innovation for DR screening and ophthalmology sector. Further analysis will calculate cost per QALY. Key messages: The cost per patient screened for DR with Peek is 5.73 times less than Topcon retinal camera (gold standard), while the cost per DR case detected is 5.23 times less It is widely believed that mHealth technologies may revolutionize the way health services deliver care. Peek is one of these and can be a disruptive innovation for DR screening and Ophthalmology