JMIR Publications

ABSTRACT

Background:

Diabetic retinopathy remains primary vision complication of diabetes and leading cause of blindness among adults, with up to 30% prevalence among low-income population. Tele-retina is cost-effective screening alternative to vision loss prevention, yet there is adverse association between screening and income. Intersectionality theory notes barriers to achieving health equity result from intersection of personal social characteristics (i.e., race and income). Experiences at intersections are influenced by interpersonal and structural systems of oppression (i.e., racism). Studies found Tele-retina is dominant strategy to standard of care screening for at risk populations. No study has assessed economic equity impact of DR screening using theoretical foundation. Economic evaluations should consider social inferences of technologies on patient health and health care system.

Objective:

To address shortcomings related to the utilization of intersectionality theory in economic evaluations of DR screening, we propose oppression framework informed equity CEA of DR screening program.

Methods:

A deductive theoretical drive sequential multimethod approach, consisting of 1) modified delphi  2) CASE STUDY OF OPPRESSION FRAMEWORK INFORMED EQUITY CEA. Through Delphi (Panel (N=35-50) - Patient Partners, Field experts, Decision makers) we will select the social constructs to, alongside intersectionality theory, guide modification of equity informed CEA to understand impact of social constructs on economic outcomes. Social constructs will be integrated into validated Tele-retina CEA model.

Results:

The Delphi study will provide an understanding on which social factors are deemed important by the stakeholders for guiding the inequity in care access. We may input some/all social factors into the DCEA model or create distinctive context dependent scenarios.

Conclusions:

This is first Canadian study to: 1) mainstream how health equity framework and social constructs are utilized in economic assessment, 2) improve Tele-retina screening programs by using health equity lens, and 3) scale and adopt “de-novo” integration of social constructs in economic models for evaluation of other programs. Clinical Trial: Not applcable.