Bedside ROP screening and telemedicine interpretation integrated to a neonatal transport system: Economic aspects and return on investment analysis. (March 2017)

• Record Type: Journal Article
• Authors: Kovács, Gábor; Somogyvári, Zsolt; Maka, Erika; Nagyjánosi, László
• Is Part Of: Early human development. Volume 106/107(2017)
• Page Start: 1
• Page End: 5
• Publication Date: 2017-03
• Subjects: BIO binocular indirect ophthalmoscopy -- DRI digital retinal imaging -- km kilometer -- ROP retinopathy of prematurity -- NICU neonatal intensive care unit -- NPV net present value -- PCA Peter Cerny Ambulance Service -- PERP Premature Eye Rescue Program; Retinopathy of prematurity -- Bedside screening -- Telemedicine -- Digital retinal imaging -- Cost-minimization analysis; Fetus -- Periodicals; Neonatology -- Periodicals; Prenatal influences -- Periodicals; 612.65
• DOI: 10.1016/j.earlhumdev.2017.01.007
• Languages: English
• ISSNs: 0378-3782

Abstract

Abstract: Background and aim: Peter Cerny Ambulance Service – Premature Eye Rescue Program (PCA-PERP) uses digital retinal imaging (DRI) with remote interpretation in bedside ROP screening, which has advantages over binocular indirect ophthalmoscopy (BIO) in screening of premature newborns. We aimed to demonstrate that PCA-PERP provides good value for the money and to model the cost ramifications of a similar newly launched system. Methods: As DRI was demonstrated to have high diagnostic performance, only the costs of bedside DRI-based screening were compared to those of traditional transport and BIO-based screening (cost-minimization analysis). The total costs of investment and maintenance were analyzed with micro-costing method. A ten-year analysis time-horizon and service provider's perspective were applied. Results: From the launch of PCA-PERP up to the end of 2014, 3722 bedside examinations were performed in the PCA covered central region of Hungary. From 2009 to 2014, PCA-PERP saved 92, 248 km and 3633 staff working hours, with an annual nominal cost-savings ranging from 17, 435 to 35, 140 Euro. The net present value was 127, 847 Euro at the end of 2014, with a payback period of 4.1 years and an internal rate of return of 20.8%. Our model presented the NPVs of different scenarios with different initial investments, annual number of transports and average transport distances. Conclusions: PCA-PERP as bedside screening with remote interpretation, when compared to a transport-based screening with BIO, produced better cost-savings from the perspective of the service provider and provided a return on initial investment within five years after the project initiation. Highlights: The Peter Cerny Ambulance Service maintains a bedside ROP screening with digital retinal imaging and remote interpretation Between 2009 and 2014, 3, 722 bedside examinations and remote interpretation were performed The PCA-PERP saved 92, 248 km, 3, 633 of staff working hours and 17, 435 to 35, 140 Euro annual cost PCA-PERP achieved 20.8% internal rate of return and had 4.1 years payback period It was concluded that a bed-side ROP screening program with remote interpretation may be economical