The cost-effectiveness of a retinal photography screening program for preventing diabetic retinopathy in the First Nations diabetic population in British Columbia, Canada.

Seven-field stereo retinal photography is both 100% sensitive and specific for diagnosing diabetic retinopathy and is the standard for evaluating the severity of retinopathy both for clinical and epidemiological studies. It is also very useful for follow-up of diabetics and eventual treatment of complicated cases with laser and other treatment modalities. If the 450 First Nations diabetic cases that were surveyed in 1992 in British Columbia, Canada, were to receive an annual assessment by an ophthalmologist, the cost is estimated at $164,000 (Canadian). This amount includes travel, hotel, and meal costs of patients traveling to the ophthalmic centers in their areas and the fee for specialist services. Alternately, retinal photography screening is estimated to cost $61,000. This amount includes photo-technician labor, travel costs to the community, hotel and meal costs, ophthalmologist interpretation of the photographs, and annualized capital maintenance costs. In the first year, the cost of vehicle purchase with accessories and a camera with accessories is estimated at $61,000, with an estimated four-year lifespan of equipment. Maintenance and insurance, including vehicle fuel, will cost $12,256 annually. A retinal photography program could travel to the diabetic patient, and nearly 100% of First Nations diabetic patients could receive this service annually. This program could be highly effective in preventing blindness in First Nations diabetic patients in British Columbia through early intervention in diabetic retinopathy.