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Schechter CB, Basch CE, Caban A, et al. Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus. Clin Ophthalmol. 2008;2(4):763-8doi: 10.2147/opth.s3232.
Schechter, C. B., Basch, C. E., Caban, A., & Walker, E. A. (2008). Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus. Clinical ophthalmology (Auckland, N.Z.), 2(4), 763-8. https://doi.org/10.2147/opth.s3232
Schechter, Clyde B, et al. "Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus." Clinical ophthalmology (Auckland, N.Z.) vol. 2,4 (2008): 763-8. doi: https://doi.org/10.2147/opth.s3232
Schechter CB, Basch CE, Caban A, Walker EA. Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus. Clin Ophthalmol. 2008 Dec;2(4):763-8. doi: 10.2147/opth.s3232. PMID: 19668428; PMCID: PMC2699788.
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Clin Ophthalmol. 2008 Dec;2(4):763-8. doi: 10.2147/opth.s3232.

Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus.

Clinical ophthalmology (Auckland, N.Z.)

Clyde B Schechter, Charles E Basch, Arlene Caban, Elizabeth A Walker

Affiliations

  1. Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA. [email protected]

PMID: 19668428 PMCID: PMC2699788 DOI: 10.2147/opth.s3232

Abstract

In a clinical trial, we have previously shown that a telephone intervention can significantly increase participation in dilated fundus examination (DFE) screening among low-income adults with diabetes. Here the costs and cost-effectiveness ratio of this intervention are calculated. Intervention effectiveness was estimated as the difference in DFE utilization between the telephone intervention and print groups from the clinical trial multiplied by the size of the telephone intervention group. A micro-costing approach was used. Personnel time was aggregated from logs kept during the clinical trial of the intervention. Wage rates were taken from a commercial compensation database. Telephone charges were estimated based on prevailing fees. The cost-effectiveness ratio was calculated as the ratio of total costs of the intervention to the number of DFEs gained by the intervention. A sensitivity analysis estimated the cost-effectiveness of a more limited telephone intervention. A probabilistic sensitivity analysis using bootstrap samples from the clinical trial results quantified the uncertainties in resource utilization and intervention effectiveness. Net intervention costs were US$18,676.06, with an associated gain of 43.7 DFEs and 16.4 new diagnoses of diabetic retinopathy. The cost-effectiveness ratio is US$427.37 per DFE gained. A restricted intervention limiting the number of calls to 5, as opposed to 7, would achieve the same results, but would cost approximately 17% less. In the probabilistic sensitivity analysis, the 5th and 95th percentiles of the cost-effectiveness ratio were US$304.05 and US$692.52 per DFE gained, respectively. Our telephone intervention is more expensive than simple mail or telephone reminders used in other settings to promote preventive care; it is, however, also considerably more effective, and is effective in a low-income minority population at greater risk for diabetes complications. The costs are dominated by labor costs, and may be substantially defrayed, without loss of effectiveness, by restricting the number of telephone calls to 5 per patient.

Keywords: cost-effectiveness; diabetes mellitus; dilated fundus examination

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