Screening for Diabetic Retinopathy: Cost-Effectiveness Analysis of Direct Eye Examination versus Telescreening in Rio Grande Valley, Texas Open Access

Abstract

Diabetic retinopathy poses a significant health concern in underserved and isolated, Hispanic-populated Rio Grande Valley, Texas. Hispanics have greater risk of contracting diabetic retinopathy compared to other races due to many reasons, including socioeconomics and behavioral risk factors. Diabetes is also significantly prevalent in Rio Grande Valley, increasing the risk of developing diabetic retinopathy among the target population.

Screening provides an effective way to reduce the burden of the disease. There are alternative methods of screenings for diabetic retinopathy: direct eye examination and retinal photography followed by necessary eye care and/or both, with tradeoffs to consider. Therefore, cost, access and quality concerns associated with different screening alternatives ought to be considered before implementing a strategy at population-level.

Rio Grande Valley's residents are dispersed and lack compliance to seek follow-up care. With higher prevalence, little access to preventive care, and greater cultural and economic barriers, finding cost-effective ways of reaching and screening diabetes patients in these Hispanic-populated regions is critical. By conducting a literature search and running a cost-effectiveness analysis of telescreening in primary care settings vs. direct eye examination by retina specialists, this study provides an economical model to enhance access to and quality of screening diabetes patients for diabetic retinopathy in Rio Grande Valley, Texas.

Table of Contents

Table of Contents

Chapter 1: Introduction

1.1 Introduction and Rational

1.2 Problem Statement

1.3 Theoretical Framework

1.4 Purpose Statement

1.5 Significance Statement

1.6 Terms and Abbreviations

Chapter 2: Review of the Literature

2.1 Introduction 2.2 Literature Review

2.3 Summary of Current Problem and Study Relevance

Chapter 3: Methodology 3.1 Introduction 3.2 Population and Sample 3.3 Research Study Design 3.4 Procedures 3.5 Data Analysis Plan 3.6 Limitations and Delimitations Chapter 4: Results 4.1 Introduction 4.2 Findings Summary

Chapter 5: Conclusions, Implications and Recommendations

5.1 Introduction

5.2 Summary of Study 5.3 Conclusions 5.4 Implications 5.5 Recommendations References

Appendix S1: Search terms and strategies

Appendix S2: A simplified yearlong decision scenario for diabetic retinopathy screening

List of tables and figures

Figure 2.1: Flow of study selection

Figure 4.1: Estimated prevalence of diabetic retinopathy in Rio Grande Valley, Texas

Table 2.1: Inclusion criteria for data sources

Table 2.2: Inclusion criteria for study models

Table 2.3: Summary of health screening studies for diabetic retinopathy

Table 2.4: Economic analysis of telescreening for diabetic retinopathy

Table 3.1: Intervention activities during eye exams and telescreening

Table 3.2: Tangible direct medical costs Table 3.3: Tangible direct non-medical costs

Table 4.1: Approximate intermediate and final outcome measures

Table 4.2: Cost of outcomes

Table 4.3: Decision tree cost calculations

Table 4.4: Cost, access and outcome data .

Table 4.5: ICER summary

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Cost-effectiveness analysis Diabetic retinopathy Telescreening
Committee Chair / Thesis Advisor	Miner, Kathleen R, Emory University
Committee Members	Yang, Zhou, Rollins School of Public Health
Partnering Agencies	Does not apply (no collaborating organization)

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