Economic Evaluation of Diabetic Retinopathy Screening in Developing Countries: A Systematic Review.

purposeThe purpose of this study was to evaluate economic aspect of diabetic retinopathy (DR) screening strategies in developing countries. It focused on the cost-effectiveness of artificial intelligence (AI) and telemedicine compared to standard care.

methodsA structured literature search was conducted using PubMed, ScienceDirect, the Cochrane Library, and Google Scholar. Studies were included if they involved patients with type 1 or type 2 diabetes mellitus, conducted in low- or middle-income countries at the time of the study, compared AI or telemedicine-based intervention with standard care, and performed a health economic assessment or provided sufficient data to assess cost-effectiveness.

resultsSeven studies were identified from China, Thailand, Brazil, and India. Of these, four applied cost-utility analysis, two used cost-effectiveness analysis, and one employed both approaches. Three studies evaluated AI-based screening, three focused on telemedicine, and one examined a combined AI-assisted telemedicine model. All studies compared these interventions to standard care, with some using no screening as the comparator. Across all studies, AI and telemedicine-based screening strategies were found to be cost-effective, though the degree of economic benefit varied depending on the model, setting, and assumptions used.

conclusionsThis review supports the cost-effectiveness and feasibility of AI- and telemedicine-based DR screening in developing countries. While most strategies proved economically viable, cost savings and health gains varied. Screening frequency and patient compliance were key factors influencing successful implementation.