Cost analysis of remote telemedicine screening for retinopathy of prematurity

Objective: To compare costs of 2 screening modalities for retinopathy of prematurity (ROP): telemedicine imaging with remote interpretation versus in-person binocular indirect ophthalmoscopy (BIO). Design: Retrospective chart review. Participants: Infants from an existing telemedicine screening program at 2 cities in Ontario, Canada. Methods: We conducted a cost analysis comparison from the perspective of the Ministry of Health. Patient level data was used for the telemedicine group. A hypothetical control group consisted of the minimum number of BIO and interhospital transfers if the existing patients were screened in person. Costs included in-person examinations, transfers, setting up, and ongoing costs of telemedicine screening. Costs were compared using the Mann-Whitney U test and are reported in 2014 Canadian dollars. Results: A total of 102 and 72 infants were screened from Sudbury and Barrie, respectively; 3% and 2% of infants in the telemedicine group were transferred for BIO from Sudbury and Barrie, respectively. All infants in the control group would have required at least one transfer for BIO. The average total cost per eye examination was $4855 +/- $5616 and $4540 +/- $3129 for the telemedicine group and $19 834 +/- $13 814 and $2429 +/- $1664 for the control group from Sudbury and Barrie, respectively (p < 0.001). Interhospital transfer cost for the control group was $19 489 +/- $13 605 and $2055 +/- $1471 compared to $635 +/- $3968 and $30 +/- $197 for the telemedicine group (p < 0.001) in Sudbury and Barrie, respectively. Conclusions: Telemedicine appears to be an economically attractive option depending on the location and number of infants screened. This information is useful for planning similar ROP screening programs.