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

Clyde B Schechter1, Charles E Basch2, Arlene Caban3, Elizabeth A Walker41Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA; 2Department of Health Behavior Studies, Teachers College, Columbia University, New Yor...

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Autores principales:	Clyde B Schechter, Charles E Basch, Arlene Caban, Elizabeth A Walker
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2008
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/9d3353daac4344d5b4f3607b7c576a54
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spelling	oai:doaj.org-article:9d3353daac4344d5b4f3607b7c576a542021-12-02T01:26:57ZCost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus1177-54671177-5483https://doaj.org/article/9d3353daac4344d5b4f3607b7c576a542008-05-01T00:00:00Zhttp://www.dovepress.com/cost-effectiveness-of-a-telephone-intervention-to-promote-dilated-fund-a378https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Clyde B Schechter1, Charles E Basch2, Arlene Caban3, Elizabeth A Walker41Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA; 2Department of Health Behavior Studies, Teachers College, Columbia University, New York, NY, USA; 3Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; 4Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USAAbstract: 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 Clyde B SchechterCharles E BaschArlene CabanElizabeth A WalkerDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2008, Iss Issue 4, Pp 763-768 (2008)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Clyde B Schechter Charles E Basch Arlene Caban Elizabeth A Walker Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus
description	Clyde B Schechter1, Charles E Basch2, Arlene Caban3, Elizabeth A Walker41Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA; 2Department of Health Behavior Studies, Teachers College, Columbia University, New York, NY, USA; 3Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; 4Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USAAbstract: 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
format	article
author	Clyde B Schechter Charles E Basch Arlene Caban Elizabeth A Walker
author_facet	Clyde B Schechter Charles E Basch Arlene Caban Elizabeth A Walker
author_sort	Clyde B Schechter
title	Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus
title_short	Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus
title_full	Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus
title_fullStr	Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus
title_full_unstemmed	Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus
title_sort	cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus
publisher	Dove Medical Press
publishDate	2008
url	https://doaj.org/article/9d3353daac4344d5b4f3607b7c576a54
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Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus

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