ouths and adults with diabetes are at risk for diabetic retinopathy (DR), which can lead to vision loss. 1 The prevalence of DR among youths with type 1 diabetes (T1D) and type 2 diabetes (T2D) ranges from 4% to 13%. [2][3][4] Despite recommendations from the American Diabetes Association and American Academy of Ophthalmology for yearly screening, adherence remains low. 5 Although the prevalence is low among youths, the risk of developing DR is high. Diabetic retinopathy is present in up to 50% of patients with T1D 28 years or more after diagnosis 6,7 and already present at the time of diagnosis in 12% to 19% of patients with T2D. 4 Digital teleophthalmology systems that use nonmydriatic cameras have been implemented to improve DR screen-ing rates 8,9 and are cost-effective. 10 Digital fundus photography can be efficiently and safely performed without pupil dilation, including in the pediatric setting. 3,[11][12][13][14] Recently, the US Food and Drug Administration (FDA) approved the first autonomous artificial intelligence (AI) diagnostic system to detect DR in adults. With this system, a minimally trained operator guided by an image-quality AI takes retinal images with a nonmydriatic fundus camera, and these images are subsequently assessed in real time at the point of care (POC) for the presence or absence of DR. 15 In 2020, this form of FDA-validated autonomous AI became part of the American Diabetes Association standard of care for DR screening. 16 IMPORTANCE Screening for diabetic retinopathy is recommended for children with type 1 diabetes (T1D) and type 2 diabetes (T2D), yet screening rates remain low. Point-of-care diabetic retinopathy screening using autonomous artificial intelligence (AI) has become available, providing immediate results in the clinic setting, but the cost-effectiveness of this strategy compared with standard examination is unknown.OBJECTIVE To assess the cost-effectiveness of detecting and treating diabetic retinopathy and its sequelae among children with T1D and T2D using AI diabetic retinopathy screening vs standard screening by an eye care professional (ECP).
DESIGN, SETTING, AND PARTICIPANTSIn this economic evaluation, parameter estimates were obtained from the literature from 1994 to 2019 and assessed from March 2019 to January 2020. Parameters included out-of-pocket cost for autonomous AI screening, ophthalmology visits, and treating diabetic retinopathy; probability of undergoing standard retinal examination; relative odds of undergoing screening; and sensitivity, specificity, and diagnosability of the ECP screening examination and autonomous AI screening.
MAIN OUTCOMES AND MEASURESCosts or savings to the patient based on mean patient payment for diabetic retinopathy screening examination and cost-effectiveness based on costs or savings associated with the number of true-positive results identified by diabetic retinopathy screening.
RESULTSIn this study, the expected true-positive proportions for standard ophthalmologic screening by an ECP were 0.006 for T1D and 0.01 for...