The cost-utility of telemedicine to screen for diabetic retinopathy in India.

PURPOSE: To assess the cost-effectiveness of a telemedicine diabetic retinopathy (DR) screening program in rural Southern India that conducts 1-off screening camps (i.e., screening offered once) in villages and to assess the incremental cost-effectiveness ratios of different screening intervals. DESIGN: A cost-utility analysis using a Markov model. PARTICIPANTS: A hypothetical cohort of 1000 rural diabetic patients aged 40 years who had not been previously screened for DR and who were followed over a 25-year period in Chennai, India. METHODS: We interviewed 249 people with diabetes using the time trade-off method to estimate utility values associated with DR. Patient and provider costs of telemedicine screening and hospital-based DR treatment were estimated through interviews with 100 diabetic patients, sampled when attending screening in rural camps (n = 50) or treatment at the base hospital in Chennai (n = 50), and with program and hospital managers. The sensitivity and specificity of the DR screening test were assessed in comparison with diagnosis using a gold standard method for 346 diabetic patients. Other model parameters were derived from the literature. A Markov model was developed in TreeAge Pro 2009 (TreeAge Software Inc, Williamstown, MA) using these data. MAIN OUTCOME MEASURES: Cost per quality-adjusted life-year (QALY) gained from the current teleophthalmology program of 1-off screening in comparison with no screening program and the cost-utility of this program at different screening intervals. RESULTS: By using the World Health Organization threshold of cost-effectiveness, the current rural teleophthalmology program was cost-effective ($1320 per QALY) compared with no screening from a health provider perspective. Screening intervals of up to a frequency of screening every 2 years also were cost-effective, but annual screening was not (>$3183 per QALY). From a societal perspective, telescreening up to a frequency of once every 5 years was cost-effective, but not more frequently. CONCLUSIONS: From a health provider perspective, a 1-off DR telescreening program is cost-effective compared with no screening in this rural Indian setting. Increasing the frequency of screening up to 2 years also is cost-effective. The results are dependent on the administrative costs of establishing and maintaining screening at regular intervals and on achieving sufficient coverage

An Investigation of Teacher/Pupils Ratios on the Internal Efficiency Indicators of Mvomero District and Morogoro Municipality

This study investigated the Teacher/Pupils Ratios on the Internal Efficiency Indicators of Mvomero District and Morogoro Municipal. Five objectives were set; the Teacher Pupils Ratio for remote and peripheral schools compared to urban schools against internal efficiency parameters such as, the dropout rate, the transition rate, the pass rate, and the repetition rates. Methodologically both qualitative and quantitative approaches were used for data collection and analysis. Focused group discussions (FGD), semi–structured interviews, questionnaires and unpublished documentary reviews were used as instruments for data collection. The results of this study show that there are wide TPR between Morogoro urban 1:48 and Mvomero district 1:58; concerning dropout rates there are differences between Morogoro Municipality and Mvomero district schools. In terms of repetition rate the findings indicate that there is difference of 15 per cent between Morogoro urban with an average of 37 per cent in Mvomero district schools with an average of 22 per cent for Morogoro municipality schools. The transition rate shows that there is a lower transition rate in Mvomero district schools of 62 per cent compared to Morogoro Municipality of 82 per cent. The pass rate in Mvomero district schools was 74 per cent compared to Morogoro urban schools of 96 per cent. The remotely located schools in Mvomero are not attractive to teachers because they lack essential services as indicated in the text. It is recommended that the Government provide hardship allowances or the schools advertise the vacancies so that those who apply are those prepared to live and work in the remote and peripheral locations