{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:41:53Z","timestamp":1777876913328,"version":"3.51.4"},"reference-count":35,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Telemedicine and e-Health"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To determine the cost-effectiveness of a new telemedicine optometric-based screening program of diabetic retinopathy (DR) compared with traditional models\u2019 assessments in a universal European public health system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A new teleophthalmology program for DR based on the assessment of retinographies (3-field Joslin Vision Network by a certified optometrist and a reading center [IOBA-RC]) was designed. This program was first conducted in a rural area 40 km from the referral hospital (Medina de Rioseco, Valladolid, Spain). The cost-effectiveness was compared with telemedicine based on evaluations by primary care physicians and general ophthalmologists, and to face-to-face examinations conducted by ophthalmologists. A decision tree model was developed to simulate the cost-effectiveness of both models, considering public and private costs. The effectiveness was measured in terms of quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 261 patients with type 2 diabetes were included (42 had significant DR and required specific surveillance by the RC; 219 were undiagnosed). The sensitivity and specificity of the detection of DR were 100% and 74.1%, respectively. The telemedicine-based DR optometric screening model demonstrated similar utility to models based on physicians and general ophthalmologists and traditional face-to-face evaluations (0.845) at a lower cost\/patient (\u20ac51.23, \u20ac71.65, and \u20ac86.46, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The telemedicine-based optometric screening program for DR in a RC demonstrated cost savings even in a developed country with a universal health care system. These results support the expansion of this kind of teleophthalmology program not only for screening but also for the follow-up of diabetic patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/tmj.2024.0353","type":"journal-article","created":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T04:22:16Z","timestamp":1722399736000},"page":"2824-2833","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Cost-Effectiveness of a Telemedicine Optometric-Based Assessment for Screening Diabetic Retinopathy in a Country with a Universal Public Health System"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6392-8581","authenticated-orcid":false,"given":"Sara","family":"Ortiz-Toquero","sequence":"first","affiliation":[{"name":"IOBA Eye Institute, University of Valladolid, Valladolid, Spain."},{"name":"Department of Theoretical Physics, Atomic and Optics, University of Valladolid, Valladolid, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guillermo","family":"Aleixandre","sequence":"additional","affiliation":[{"name":"Department of Applied Economics, University of Valladolid, Valladolid, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yolanda","family":"Valpuesta","sequence":"additional","affiliation":[{"name":"Medina de Rioseco Healthcare Center, Salud Castilla y Le\u00f3n, Medina de Rioseco, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Perez Fernandez","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Clinic Hospital of Valladolid, Valladolid, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Purificaci\u00f3n","family":"de la Iglesia","sequence":"additional","affiliation":[{"name":"Regional Ministry of Health (Direcci\u00f3n General de Asistencia Sanitaria, Consejer\u00eda de Sanidad), Valladolid, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Carlos","family":"Pastor","sequence":"additional","affiliation":[{"name":"IOBA Eye Institute, University of Valladolid, Valladolid, Spain."},{"name":"Department of Ophthalmology, University Clinic Hospital of Valladolid, Valladolid, Spain."},{"name":"RICORS (Thematic Network of the Carlos III, Institute of Health, Inflammation and immunopathology of organs and systems), Madrid, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maribel","family":"Lopez-Galvez","sequence":"additional","affiliation":[{"name":"IOBA Eye Institute, University of Valladolid, Valladolid, Spain."},{"name":"Department of Ophthalmology, University Clinic Hospital of Valladolid, Valladolid, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,12,6]]},"reference":[{"key":"e_1_3_5_2_2","unstructured":"World Health Organization. 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