Cost assessment of diabetic retinopathy screening in a community setting

Purpose: To assess the costs associated with a community-based program to screen adults for diabetic retinopathy. Methods: Free screening for diabetic retinopathy and visual acuity was offered to adult diabetics at a community health center in a low socioeconomic area of Miami-Dade County. If fundus photos showed abnormalities, referrals were made for follow-up care. Data were collected on start-up costs (e.g., capital equipment) and continuing costs (e.g., personnel, fees for reading retinal scans, supplies). Total costs, cost per person screened and per referral were calculated. Different assumptions for cost distributions and the life-span of capital equipment were made for sensitivity analyses. Results: In the first 9 months, 477 adults were screened: 44% blacks, 55% Hispanics, and 64% women. The average age of participants was 55.8 (sd=9.5). The average time since diagnosed with diabetes was 9.6 years (sd=8.3). Most (79%) had no health insurance, 44% had no eye exam in the last 2 years, and 10% had never had an eye exam. Referrals were made for 121 abnormal scans. Total intervention cost to-date was $85,714. Distributing start-up costs among all participants, cost/screening was $179 and cost/referral $708. Assuming that all equipment will last 3 (5) years, the estimated cost/screening was $135 ($129) and cost/referral $531 ($507). Conclusions: Most participants had no health insurance nor a recent eye exam, and 25% needed referrals, demonstrating the need for the screening program. The program's relatively low-cost illustrates that such a community-based intervention could be widely adopted.