Retinopathy of prematurity: the high cost of screening regional and remote infants

Abstract:

Importance: Demand for Retinopathy of Prematurity screening, is increasing for infants born at rural and regional hospitals where the service is not generally available. The health system cost for screening regional/remote infants has not been reported. Background: The objective of this study is to evaluate the cost of Retinopathy of Prematurity screening at a large centralised tertiary neonatal service for infants from regional/rural hospitals. Design: This is a retrospective study to establish the cost of transferring regional/rural infants to the Royal Brisbane and Women's Hospital for ROP screening over a 28 month period. Participants: 131 infants were included in this study. Methods: Individual infant costs were calculated from analysis of clinical and administrative records. Main Outcome Measures: Economic cost of ROP screening for all transfers from regional/rural hospitals to Royal Brisbane and Women's Hospital. Results: The average economic cost of ROP screening for this cohort was AUD$5110 per infant screened and the total cost was AUD$669,413. The average cost per infant screened was highest for infants from a regional centre with a population of 75,000 (AUD$14,856 per child), which was also geographically furthest from Brisbane. No infant in this cohort transferred from a regional nursery reached criteria for intervention for ROP by standard guidelines. Conclusions and Relevance: Health system costs for ROP screening of remote infants at a centralised hospital are high. Alternative strategies using telemedicine can now be compared with centralized screening.