Table 1 Presents in short the difference between articles
First Author, Year, Country | Population size | DM type | Comparator | Screening modality | Outcome | Results | Quality of the evidence GRADEa and CEBMb |
|---|---|---|---|---|---|---|---|
Rachapelle, 2013, India | 1000 | Not specified | No screening | Mobile van with an a-built-in ophthalmic unit in which an optometrist took retinal images that were transferred by satellite to the base hospital, where they were reviewed by an ophthalmologist and graded using the international DR classification system | ICERc | From the health provider perspective: Screening every 2 years—$2435 per QALYd gained (within cost-effective range); Annual screening—$4029 per QALY gained (outside cost-effective range). Annual screening—not in the cost-effective range From the societal perspective: Screening every 5 years—$3134 per QALY gained (within cost-effective range). Screening every 2 years—$3669 per QALY gained (outside cost-effective range) | Moderate Due to risk of bias CEBM: 3b Individual case–control study |
Kirkizlar, 2013, US | 900 | Type 1 and type 2 DM | Eye care professional performing a conventional retinal examination | Digital images were taken by a technician and sent electronically to a central location for reading by a retinal specialist or certified reader | Cost per QALYd | $46,449 per QALY for screening 3500 patients (decreasing as patient pool size increasing) Cost/QALY for patients over 50 years—$7228 (increasing as patient age increasing) | Low Due to the risk of bias and Imprecision CEBM: 3b Individual case–control study |
Nguyen, 2016, Singapore | Hypothetical cohort of patients | Type 2 DM | Primary care physician | Retinal images were transmitted to an ocular imaging center. Trained graders assessed the severity of DR and sent the results back to the primary physician (within a 1-h turnaround time) | Cost per QALYd | The telemedicine-based DR screening generates cost savings of $127 saving per patient with similar QALY | Low Due to the risk of bias and indirectness of evidence CEBM: 3b Individual case–control study |
Khan, 2013, South Africa | 14,541 | Type 2 DM | No screening | Retinal photographs were taken by mobile camera transport in a vehicle and read by a medical officer with ophthalmic experience | ICER and costs | $1206 per blindness case averted Potential cost-savings—$19,310,344 per year | Low Due to the risk of bias and Imprecision CEBM: 3b Individual case–control study |
Kanjee, 2017, Canada | 4676 | Type 2 DM | The existing service, the retinal specialist provides in-clinic screening | Retinal images transmitted to a centralized reading facility and graded by a retinal specialist | Costs | The telemedicine program produced savings of $752 per examination performed | Low Due to the risk of bias and Imprecision CEBM: 3b Individual case–control study |
Ben, 2020, Brazil | (1) Opportunistic Ophthalmologist referral to secondary care individuals who seek medical attention at primary care. (2) Systematic ophthalmology referral for all individuals with diabetes | Systematic teleophthalmology-based. Retinal images were taken from individuals and were sent to a remote ophthalmology center for evaluation | Costs and ICER and QALY | The systematic teleophthalmology based screening was more effective although more expensive, with an additional cost of $209 and incremental QALY of 0.042; thus the ICER of this intervention was $4976/QALY | Moderate Due to the risk of bias CEBM: 3b Individual case–control study | ||
Stanimirovic, 2019, Canada (Toronto) | 566 | Type 1 and type 2 DM | Fundus examination by optometrist or ophthalmologist | Retinal images were taken and uploaded to a server and graded for the level of DR by a retina specialist | Costs and ICER | The teleretinal screening program correctly diagnosed more patients (496 vs. 247) and was cost-saving ($82.4 vs. $237.8) | Moderate Due to the risk of bias CEBM: 3b Individual case–control study |