Ee Lin Ong, Russell Gruen, Angus Taylor

Introduction: Inequities in eye health between rural and urban populations are a catalyst for change in every health system. Existing models of care include subsidised patient travel to regional centres and mobile outreach services. Tele-ophthalmology presents an attractive alternative model of care for rural and remote populations, with the potential of improving accessibility for specialist ophthalmic care. We aim to compare the costs and consequences of different service models eye care delivery to remote communities, reported from a health service perspective.

Methods: Costs and outcomes of subsidised patient travel to outpatient clinics, specialist outreach services and tele-ophthalmology clinic models were compared using cost-consequence analysis principles. Cumulative costs were estimated by quantifying staff resources and travel costs for each clinic model. Quantitative and qualitative health service evaluation metrics were analysed, including marginal cost estimates and consequences.

Results: The marginal costs per patient for each clinic model were $506 for patient travel, $391 for outreach clinics and $147 for tele-ophthalmology. Apart from potential cost-savings in replacing a proportion of face-to-face consultations, tele-ophthalmology may provide added advantages of timely care, opportunities for multi- disciplinary education and minimisation of time away from usual activities for both patient and ophthalmologist.

Conclusion: Subsidised patient travel for outpatient ophthalmic care and outreach ophthalmology services posed greater burden to health service and patients as compared to tele-ophthalmology. This has implications for the planning of a broad range of specialist outreach services, where tele-health could be used to optimise care to remote populations in conjunction with existing service delivery models.