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- Title
Modelling the cost-effectiveness of adopting risk-stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland.
- Authors
Scotland, G.; McKeigue, P.; Philip, S.; Leese, G. P.; Olson, J. A.; Looker, H. C.; Colhoun, H. M.; Javanbakht, M.
- Abstract
Aims To assess the cost-effectiveness of adopting risk-stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland. Methods A continuous-time hidden Markov model was fitted to national longitudinal screening data to derive transition probabilities between observed non-referable and referable retinopathy states. These were incorporated in a decision model simulating progression, costs and visual acuity outcomes for a synthetic cohort with a covariate distribution matching that of the Scottish diabetic screening population. The cost-effectiveness of adopting extended (2-year) screening for groups with no observed retinopathy was then assessed over a 30-year time horizon. Results Individuals with a current grade of no retinopathy on two consecutive screening episodes face the lowest risk of progressing to referable disease. For the cohort as a whole, the incremental cost per quality-adjusted life year gained for annual vs. biennial screening ranged from approximately £74 000 (for those with no retinopathy and a prior observed grade of mild or observable background retinopathy) to approximately £232 000 per quality-adjusted life year gained (for those with no retinopathy on two consecutive screening episodes). The corresponding incremental cost-effectiveness ratios in the subgroup with Type 1 diabetes were substantially lower; approximately £22 000 to £85 000 per quality-adjusted life year gained, respectively. Conclusions Biennial screening for individuals with diabetes who have no retinopathy is likely to deliver significant savings for a very small increase in the risk of adverse visual acuity and quality of life outcomes. There is greater uncertainty regarding the long-term cost-effectiveness of adopting biennial screening in younger people with Type 1 diabetes.
- Subjects
SCOTLAND; BLINDNESS; DIAGNOSIS of diabetes; AGE distribution; COST effectiveness; DIABETIC retinopathy; PEOPLE with diabetes; ECONOMICS; MEDICAL needs assessment; MEDICAL screening; NATIONAL health services; QUALITY of life; RESEARCH funding; RISK assessment; VISUAL acuity; DATA analysis; DISEASE incidence; DISEASE duration; DISEASE complications; DIAGNOSIS; PREVENTION
- Publication
Diabetic Medicine, 2016, Vol 33, Issue 7, p886
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/dme.13129