Cost-effectiveness of a National Telemedicine Diabetic Retinopathy Screening Program in Singapore
Abstract
Purpose To determine the incremental cost-effectiveness of a new telemedicine technician-based assessment relative to an existing model of family physician (FP)-based assessment of diabetic retinopathy (DR) in Singapore from the health system and societal perspectives. Design Model-based, cost-effectiveness analysis of the Singapore Integrated Diabetic Retinopathy Program (SiDRP). Participants A hypothetical cohort of patients aged 55 years with type 2 diabetes previously not screened for DR. Methods The SiDRP is a new telemedicine-based DR screening program using trained technicians to assess retinal photographs. We compared the cost-effectiveness of SiDRP with the existing model in which FPs assess photographs. We developed a hybrid decision tree/Markov model to simulate the costs, effectiveness, and incremental cost-effectiveness ratio (ICER) of SiDRP relative to FP-based DR screening over a lifetime horizon. We estimated the costs from the health system and societal perspectives. Effectiveness was measured in terms of quality-adjusted life-years (QALYs). Result robustness was calculated using deterministic and probabilistic sensitivity analyses. Main outcome measures The ICER. Results From the societal perspective that takes into account all costs and effects, the telemedicine-based DR screening model had significantly lower costs (total cost savings of S$173 per person) while generating similar QALYs compared with the physician-based model (i.e., 13.1 QALYs). From the he…
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Previous studies only focused on theoretical scenarios where sensitivity and specificity can change independently.
“However, these studies only focused on theoretical scenarios where sensitivity and specificity can change independently, overlooking that in practical screening tools, these two parameters have an inverse correlation.”
From Economic evaluation for medical artificial intelligence: accuracy vs. cost-effectiveness in a diabetic retinopathy screening case (2024) · cites this paper as [16]
Previous studies evaluating cost-effectiveness of AI models assigned different values to sensitivity and specificity.
“To evaluate cost-effectiveness change, previous studies assigned different values to the sensitivity and specificity of AI models14–16.”
From Economic evaluation for medical artificial intelligence: accuracy vs. cost-effectiveness in a diabetic retinopathy screening case (2024) · cites this paper as [16]
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- Authors
- Nguyen, H. V., Tan, G. S. W., Tapp, R. J., Mital, S., Ting, D. S. W., Wong, H. T., Tan, C. S., Laude, A., Tai, E. S., Tan, N. C., Finkelstein, E. A., Wong, T. Y., & Lamoureux, E. L.
- Affiliations
- Memorial University of Newfoundland (CA)
- Singapore National Eye Center (SG)
- The University of Melbourne (AU)
- Duke-NUS Medical School (SG)
- National University of Singapore (SG)
- Tan Tock Seng Hospital (SG)
- SingHealth Polyclinics (SG)
- Corresponding author
- Lamoureux, Ecosse L.
- ORCID
- Venue
- Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2016-12
- Volume
- 123
- Issue
- 12
- Pages
- 2571-2580
- ISSN
- 0161-6420 (ISSN-L)
- OpenAlex
- W2528856486
- Cited by
- 218
- References
- 0
- Citations by year
- 2026: 15 · 2025: 21 · 2024: 28 · 2023: 33 · 2022: 32 · 2021: 27 · 2020: 25 · 2019: 16 · 2018: 11 · 2017: 9
- FWCI
- 23.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- diabetic retinopathy screening, telemedicine, cost-effectiveness, type 2 diabetes, fundus photography, quality-adjusted life years, primary care, health system costs, social costs
- MeSH terms
- Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Female, Humans, Male, Markov Chains, Mass Screening, Middle Aged, National Health Programs, Singapore, Health Care Costs, Telemedicine, Quality-Adjusted Life Years
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