Table 9: List of resources to be considered in the economic analysis Provider of resource Setting in which resource is provided Proportion of patients receiving resource Number of units of resource per relevant time horizon per patient receiving resource Disaggregated unit cost MBS Safety nets* Other govt budget Private health insurer Patient Total cost Resources provided to deliver proposed intervention Acquisition of images a non-mydriatic retinal camera Appropriately trained staff (e.g. health worker, technician) OR general practitioner Various primary care settings Initially, 100% + All patients who continue to screen negative for DR receive ongoing those positive for DR referred 1 service per patient every 2 years (every year for Indigenous patients), as per NHMRC guidelines Proposed item $50 TBD $50 Professional consultation General practitioner Initially 100% + All patients who continue to screen negative for DR 2-yearly per patient (yearly if Indigenous) Resources provided in association with the proposed intervention Reading of images General practitioner OR Optometrist Clinic, consulting (may be Initially 100% + All patients who 2-yearly per patient (yearly if Indigenous) TBD
OR Ophthalmologist OR Trained reader (?) performed remotely) continue to screen negative for DR Resources provided following the proposed intervention CEE Optometrist OR ophthalmologist Consulting rooms Majority of patients who screen positive for DR referred for CEE (some DR patients may be appropriately managed within optometric practice alone) Max 1 service per patient every 2 years (every year for Indigenous patients) Ophthalmologist - retinopathy requiring treatment - photocoagulation, and/or Ophthalmologist Consulting rooms 1 or more courses depending on patient’s response to therapya Photocoagulation item: Item no. 42809 $451.10 $338.35 (75%) Anti-VEGF treatments are not PBS approved for treatment of the For this indication, treatment is an “out-of-pocket” cost
Resources provided to deliver ophthalmoscopy (as alternative to RP-NMRC) Consultation with general practitioner General practitioner Consulting rooms 1 service per patient every 2 years (every year for Indigenous patients) Resources provided in association with ophthalmoscopy (as alternative to RP-NMRC) Mydriatic (adequate fundus examination with an ophthalmoscope is considered limited without mydriasis)c General practitioner Not available through the PBS Consulting rooms Max 1 unit of mydriatic per patient 2 years (every year for Indigenous patients) TBD Supply arrangement will need to be researched Resources provided to deliver CEE (as alternative to RP-NMRC) Consultation with optometrist or ophthalmologist, including slit lamp biomicroscopy (retinal photography using mydriasis may also be applicable) Optometrist OR ophthalmologist Consulting rooms 1 service per patient 2 years (every year for Indigenous patients) Item no. 10915 $71.00 $60.35 (85%) Item no. 10916 $35.55 $30.25 Retinal photography is an additional cost to the patient (i.e. may be conducted but not billed as part of the
(85%) comprehensive exam) Resources provided in association with CEE (as alternative to RP-NMRC) Acquisition and reading of retinal images (if retinal photography with comprehensive exam) Optometrist OR ophthalmologist PBS Consulting rooms All patients who continue to screen negative for DR receive ongoing exams; patients who screen positive receive treatment as necessary 1 service per patient every 2 years (every year for Indigenous patients) Retinal photography is an additional cost to the patient (i.e. may be conducted but not billed as part of the comprehensive exam) Mydriatic agent(s) Optometrist OR Ophthalmologist Not available through the PBS Consulting rooms Max 1 unit of mydriatic per patient every 2 years (every year for Indigenous patients) TBD Supply arrangement will need to be researched Abbreviations: RP-NMRC, retinal photography using a non-mydriatic camera; CEE, comprehensive eye examination; TBD, to be determined; PBS, pharmaceutical *Include relating to both the standard and extended safety net.