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- Title
Cost-effectiveness of Autonomous Point-of-Care Diabetic Retinopathy Screening for Pediatric Patients With Diabetes.
- Authors
Wolf, Risa M.; Channa, Roomasa; Abramoff, Michael D.; Lehmann, Harold P.
- Abstract
<bold>Importance: </bold>Screening for diabetic retinopathy is recommended for children with type 1 diabetes (T1D) and type 2 diabetes (T2D), yet screening rates remain low. Point-of-care diabetic retinopathy screening using autonomous artificial intelligence (AI) has become available, providing immediate results in the clinic setting, but the cost-effectiveness of this strategy compared with standard examination is unknown.<bold>Objective: </bold>To assess the cost-effectiveness of detecting and treating diabetic retinopathy and its sequelae among children with T1D and T2D using AI diabetic retinopathy screening vs standard screening by an eye care professional (ECP).<bold>Design, Setting, and Participants: </bold>In this economic evaluation, parameter estimates were obtained from the literature from 1994 to 2019 and assessed from March 2019 to January 2020. Parameters included out-of-pocket cost for autonomous AI screening, ophthalmology visits, and treating diabetic retinopathy; probability of undergoing standard retinal examination; relative odds of undergoing screening; and sensitivity, specificity, and diagnosability of the ECP screening examination and autonomous AI screening.<bold>Main Outcomes and Measures: </bold>Costs or savings to the patient based on mean patient payment for diabetic retinopathy screening examination and cost-effectiveness based on costs or savings associated with the number of true-positive results identified by diabetic retinopathy screening.<bold>Results: </bold>In this study, the expected true-positive proportions for standard ophthalmologic screening by an ECP were 0.006 for T1D and 0.01 for T2D, and the expected true-positive proportions for autonomous AI were 0.03 for T1D and 0.04 for T2D. The base case scenario of 20% adherence estimated that use of autonomous AI would result in a higher mean patient payment ($8.52 for T1D and $10.85 for T2D) than conventional ECP screening ($7.91 for T1D and $8.20 for T2D). However, autonomous AI screening was the preferred strategy when at least 23% of patients adhered to diabetic retinopathy screening.<bold>Conclusions and Relevance: </bold>These results suggest that point-of-care diabetic retinopathy screening using autonomous AI systems is effective and cost saving for children with diabetes and their caregivers at recommended adherence rates.
- Subjects
INFORMATION storage &; retrieval systems; MEDICAL databases; ARTIFICIAL intelligence; TYPE 1 diabetes; MEDICAL screening; RETROSPECTIVE studies; TYPE 2 diabetes; CLINICAL medicine; COST effectiveness; DIABETIC retinopathy; DISEASE complications
- Publication
JAMA Ophthalmology, 2020, Vol 138, Issue 10, p1063
- ISSN
2168-6165
- Publication type
journal article
- DOI
10.1001/jamaophthalmol.2020.3190