The Effectiveness of Teleglaucoma versus In-patient Examination. Assessment: Systematic Review, Meta-Analysis, and Cost-Effectiveness Analysis

Teleglaucoma is a screening device that remotely detects glaucoma cases at earlier stages using electronically-transferred stereoscopic digital imaging. Thus, patient wait and travel times are reduced, as well as, patient load in ophthalmic clinics. The purpose is to synthesize literature to evaluate teleglaucoma: its diagnostic accuracy, the healthcare system benefits, and its cost-effectiveness. A systematic review was conducted with published and unpublished studies. A meta-analysis was conducted to provide estimates of diagnostic accuracy, diagnostic odds ratio, and the relative percentage of glaucoma cases detected. Using Markov Modelling, a cost-effectiveness analysis was conducted. Of 11237 studies reviewed, 45 were included. Teleglaucoma was more specific and less sensitive than in-person examination. The pooled estimates of sensitivity was 0.832 [95% CI 0.770, 0.881] and specificity was 0.790 [95% CI 0.668, 0.876]. The ICER calculated for teleglaucoma was $27,460/QALY. In conclusion, teleglaucoma was found to be more cost-effective than in-person examination in rural areas

The Effectiveness of Teleglaucoma versus In-Patient Examination for Glaucoma Screening: A Systematic Review and Meta-Analysis

BACKGROUND: Glaucoma is the leading cause of irreversible visual impairment in the world affecting 60.5 million people worldwide in 2010, which is expected to increase to approximately 79.6 million by 2020. Therefore, glaucoma screening is important to detect, diagnose, and treat patients at the earlier stages to prevent disease progression and vision loss. Teleglaucoma uses stereoscopic digital imaging to take ocular images, which are transmitted electronically to an ocular specialist. The purpose is to synthesize literature to evaluate teleglaucoma, its diagnostic accuracy, healthcare system benefits, and cost-effectiveness. METHODS: A systematic search was conducted to help locate published and unpublished studies. Studies which evaluate teleglaucoma as a screening device for glaucoma were included. A meta-analysis was conducted to provide estimates of diagnostic accuracy, diagnostic odds ratio, and the relative percentage of glaucoma cases detected. The improvements to healthcare service quality and cost data were assessed. RESULTS: Of 11237 studies reviewed, 45 were included. Our results indicated that, teleglaucoma is more specific and less sensitive than in-person examination. The pooled estimates of sensitivity was 0.832 [95% CI 0.770, 0.881] and specificity was 0.790 [95% CI 0.668, 0.876]. The relative odds of a positive screen test in glaucoma cases are 18.7 times more likely than a negative screen test in a non-glaucoma cases. Additionally, the mean cost for every case of glaucoma detected was $1098.67 US and of teleglaucoma per patient screened was$922.77 US. CONCLUSION: Teleglaucoma can accurately discriminate between screen test results with greater odds for positive cases. It detects more cases of glaucoma than in-person examination. Both patients and the healthcare systems benefit from early detection, reduction in wait and travel times, increased specialist referral rates, and cost savings. Teleglaucoma is an effective screening tool for glaucoma specifically for remote and under-services communities

Baseline characteristics of included studies – intervention.

<p>Baseline characteristics of included studies – intervention.</p

PRISMA diagram.

<p>PRISMA diagram.</p

Study ophthalmic examinations.

<p><b>Legend:</b> VCDR  =  vertical cup-to-disc ratio, HCDR  =  horizontal cup-to-disc ratio, IOP  =  intraocular pressure, FDT  =  frequency doubling technology, CCT  =  central corneal thickness, HRT  =  Heidelberg Retinal Tomography, CDR  = cup-to-disc ratio, HVF  =  Humphrey Visual Field, ACT  =  anterior chamber depth, POAG  =  primary open angle glaucoma, OAG  =  open angle glaucoma.</p><p>Study ophthalmic examinations.</p

Teleglaucoma estimated 2014 unit costs.

<p>Teleglaucoma estimated 2014 unit costs.</p

Study relevant outcome measures.

<p>Study relevant outcome measures.</p

Quality of analysis for costing.

<p>Quality of analysis for costing.</p

Baseline characteristics of included studies – demographics.

<p>Legend: CS  =  Cross-Sectional Study, PC  =  Prospective Cohort Study, CEA  =  Cost-effectiveness Analysis, RCS  =  Retrospective Cohort Study, EE  =  Economic Evaluation, –  =  Not Stated.</p><p>Baseline characteristics of included studies – demographics.</p

Hierarchical Summary Receiver Operating Characteristic (HSROC) plot.

<p>Hierarchical Summary Receiver Operating Characteristic (HSROC) plot.</p